Book Signing

A week or so ago, I did a book signing as part of St. Micheal's, Maryland's "3rd Friday" event. My father owns a gallery in town, and invited me to hang out there, with books, as part of the event. He also introduced me to some local media folks and others with an interest in diabetes.

This was the first time I've attempted to give the book away to a non-diabetes crowd. I actually spoke to people who could not think of anyone they knew who had diabetes (even the researchers at ADA who know more rats with diabetes than people with diabetes could think of someone they knew with it). So, unlike AADE (where people actually lined up for copies), I gave away a relatively small number of copies.

But just like AADE and ADA and the other opportunities I've had to distribute the book, I had some great conversations, and had the pleasure of seeing people light up as they realized what the book is about and that their friend, neighbor, cousin, co-worker with diabetes might be interested in a free copy.

It's a nice feeling, to say the least.

It was also very, very cool to hang out in my dad's gallery and see (and hear) people's reactions to his work. I'm not sure I impressed any potential buyers when, in response to their "who is the photographer?" queries, my first answer was "my dad!" but hopefully I didn't scare any away, either.

I'm Honored!

Just a quick post to say that my book is the featured book of the week at Children with Diabetes! Thanks CWD!

Big Fat Babies

Pregnant women with diabetes have to keep track of all sorts of numbers (carbs, ever changing insulin ratios, blood sugar results and A1c's) but perhaps the most vexing is the baby's weight. Any woman with diabetes (type 1, 2, or gestational) who has had a baby knows that diabetes contributes to macrosomia, also known as a baby that is large for gestational age (LGA). Fetal macrosomia has been defined in several different ways, including birth weight of 4000-4500 g (8 lb 13 oz to 9 lb 15 oz) or greater than 90% for gestational age after correcting for neonatal sex and ethnicity. Based on these definitions, macrosomia affects 1-10% of all pregnancies¹.

A large baby increases your chance of a premature birth, c-section, or difficult vaginal birth. Macrosomic babies are also at risk for shoulder dystocia, breathing difficulties and low blood sugar after birth.

Maternal diabetes is the most common cause of macrosomia. More precisely, maternal hyperglycemia means more sugar in the baby's blood as well. "Hyperglycemia in the fetus results in the stimulation of insulin, insulinlike growth factors, growth hormone, and other growth factors, which, in turn, stimulate fetal growth and deposition of fat and glycogen².

There are, of course, many other contributors to a baby's size (genetics, gestational age, baby's gender, and race), but those factors tend to get overlooked by both the doctor and the patient when a woman has diabetes.

When she has diabetes, a big fat baby is like a scarlet letter. Women who deliver average weight babies beam with pride over their accomplishment. Those who birth, oh, say a 10lb 10oz baby four weeks early... well, we spend a fair amount of time defending our diabetes self-management. To others, and to ourselves.

And women who walk out of their frequent ultrasound appointments with baby weight guesstimates that portend a big baby are often utterly terrified and filled with guilt. These amazing women, who are devoting every waking minute to trying to manage a disease that defies management (especially when hormones are wreaking havoc with their control) and who are committed to doing whatever it takes to have a healthy baby, these women are told or hear the message that high blood sugar equals large baby equals failure. And my heart breaks for them!

I went through two pregnancies where those other numbers (blood sugars) screamed "excellent control" but where the baby's weight (LGA from 18 weeks on) implied poor control. Which, in the eyes of your average ultrasound technician and L&D nurse, means mama didn't try hard enough.

I understand the need to put a consequence in front of people to motivate them to do their best. I just wish people would ease up on the guilt associated with diabetes numbers in general. To all you expectant moms with diabetes who are fretting over ultrasounds, please remember that estimated weight is just one piece of notoriously unreliable information, and don't beat yourself up over the prospect of a large baby! Because you have information and are being closely monitored, if your baby is large, your medical team will be prepared to deal with any potential problems. And to my sisters who delivered a big fat baby despite normal or near-normal A1cs, congratulations on the tremendous job you did bringing that new life into the world! He/she is beautiful :)

Random Report from AADE

I'm back from LA and honestly utterly exhausted! I spent Thursday, Friday and a half of Saturday working the Bayer booth in the exhibit hall. Unlike previous events, I didn't get much of a chance to walk the hall and see what's new and exciting. I just couldn't get away from the booth! I had such positive feedback from educators regarding my book that I didn't want to tear myself away!

I did swing by the Cozmo booth and get a peek at their upcoming software upgrades. Since they are not approved yet, I'm not sure if they are public, but I can say two things: "Way Cool" and "man, I love these smart pumps that can be refined based on direct user feedback!"

I behaved and avoided the medtronic booth. I mumbled under my breath whenever I saw one of their staff (nearly every vendor dresses their reps in matching shirts, so it's easy to spot folks). By way of an update, it's been a week since the latest customer service rep promised to speak to a supervisor and call me back. No rush, I guess. It's only my credit rating we're talking about.

The Bayer booth was right next to the dLife booth, so I took the time to personally congratulate Howard Steinberg and Paula Ford-Martin on their brilliant decision to hire Kerri Morrone. They tell me it's working out quite well! dLife also had Kevin Covais of American Idol fame signing and singing on the first convention day. He was very sweet, and his mom, who I talked to for about twenty minutes, was adorable. How cool must it be to be the mom of an American Idol? And get this - Kevin and Elliott were RIGHT NEXT TO EACH OTHER in line at the Boston auditions! Two type 1's out of thousands and thousands and they both made it to the 'big show'. Kinda cool if you ask me.

As always, the exhibit hall was crawling with Barton and Joslin alumni. It was great fun to hang out with camp friends. This time around, I had the pleasure of meeting two women I've 'known' for over a year via an online diabetes yahoo group. Margo and Stacey took the time to schlepp into the city on Saturday for lunch at 'the Pantry'. Between them, Margo and Stacey have eight kids. EIGHT. Stacey has a son and twin one-year-olds. Margo brought her adorable four year old son Pascal (we talked about trains and Monster Trucks) and her four - count them, FOUR - 18 month old daughters. A quad pregnancy with diabetes. As conference goers on the street noticed the stroller (how could you not?) I wanted to scream out, "This is a mom with diabetes!! Look at what we can do!!!" The connections and friendships I've made as a result of having diabetes never cease to amaze me!

Speaking of diabetes connections (I told you this was random, right?), I spent a lot of time at the Bayer booth with Peter Hoogenboom, this year's Dream Fund winner. Peter is currently 2/3rds of the way through a nearly 10,000 mile, 48 state bike ride. He locked his bike up in Minnesota and flew to LA for the conference, returning to resume his ride tomorrow I believe. Most of the time I stood next to him, I was really just in awe. Ten. Thousand. Miles. Seriously people, that is very very cool.

What else, what else... I ate some fancy food (taking full advantage of the fact that I did not have the kids with me, influencing restaurant choices), signed hundreds and hundreds of books (I could be a doctor my signature is so darn illegible), hung out with some Dex Com people (seriously, it is so cool to watch that blood sugar graph that displays on the dex com monitor), and all-in-all thoroughly enjoyed hanging out with grown ups. Missed the boys terribly, of course, but they managed to survive without me thanks to the charms of Chuck E Cheese, the movie theater, and the bowling alley.

One final note: travelling back was fine. I did have to show ID that matched the name on my insulin box prescription label (so DO pack that if you are travelling). I found myself having to do a set change on the plane due to an ungodly high blood sugar, and I was very nervous that someone would spot me assembling an electronic device with a liquid, but I managed to do it discreetly enough that no one freaked out. It probably helped that it was 3AM Eastern Standard Time.

That's it. My rambling report from AADE. Thanks for hanging in!

LA, Baby

I'm off to the AADE conference this week. I'll be distributing books at the Bayer booth in the exhibit hall, pretty much the whole time (when I'm not conducting my "Sit-in for Improved Customer Service" at the Medtronic booth). If you are attending, please come visit me!

If I bump into any celebrities while I'm there, I'll do my best to get a photo of them holding my book ;). Failing that, I'll just resort to photoshop.

I'm really looking forward to this conference, as the CDE's who attend are an enthusiastic, motivated, educated crowd who can envision how to use my book to help their patients. Between attendees, Bayer staff, and fellow camp alumni now working in the biz, there will be lots of friendly faces. This should help take the edge off of the cross-country travel!

I'm glad that you like Medtronic

But I'm furious.

They billed me $280 two years after sending my supplies to the wrong state.

I called to discuss an adjustment, given that I forfeited FSA monies, they screwed up royally, and they took so long to bill.

I was told a return call would be coming.

Today, after an exhausting and very, very expensive unplanned trip, I returned home to a bill from medtronic that is now MORE THAN DOUBLE the original amount.

Please, OCers, say a prayer for me on Monday as I attempt get anyone at Medtronic to help me.

Red Sox

Did I mention that last Thursday Jake's team won the championship game?

Came back from six runs down in the bottom of the last inning. The other team ran out of pitchers, literally. Two of their kids gave up a total of 7 runs in the end. It was brutal.

John sat the kids down at the bench for some final words, with the parents gathered round. His opening thought, "We got lucky today."

He followed that comment with, "We did not play our best game today. We made a lot of technical errors and that put us deep in a hole."

Holy cow, a grown up not kissing the kid's collective butt!

He finished strong, though, and pointed out that despite a six run deficit, the kids never stopped playing. They gave it their all until the last run, and they came out ahead. And of that he, and all of us parents, were very proud.

I took a team photo after the game, and my dad commented on how amazing it is that they are all looking at the camera. I think they were just in shock!