FDA Controls Tobacco - Not Food

President Obama and the United States Congress enacted a new law to allow the US Food and Drug Administration to control and regulate tobacco products. This is a large step for America and the fight against children using tobacco. TobaccoFreeKids.org reports that the law will allow the FDA to:

• Crack down on tobacco marketing and sales to kids.
• Ban candy and fruit-flavored cigarettes.
• Require larger, more effective health warnings on tobacco products.
• Require tobacco companies to disclose the contents of tobacco products, as well as changes in products and research about their health effects.
• Ban terms such as “light” and “low-tar” that mislead consumers into believing that certain cigarettes are safer.
• Strictly regulate all health-related claims about tobacco products to ensure they are scientifically proven and do not discourage current tobacco users from quitting or encourage new users to start.
• Empower the FDA authority to require changes in tobacco products, such as the removal or reduction of harmful ingredients.

The most interesting one to me is: "Ban terms such as “light” and “low-tar” that mislead consumers into believing that certain cigarettes are safer."

The FDA suddenly has control over tobacco and bans the use of 'light' cigarettes. You can't market a cigarette as 'light'. But the FDA has had control over Food & Drugs for a long time - and 'light' is still an acceptable word. So is 'diet' and 'sugar-free'. However the 'sugar-free' cookies, ice cream, etc. still have carbohydrates. The food may not have sugar in it but it will still raise your blood sugar very high. A lot of people are still not aware of this.

We finally stopped Big Tobacco - Now onto Big Food!

Number 4?

Yesterday Billy Mays, the OxiClean guy, passed away at age 50. This was completely unexpected because of his age and good health. However, it was even more unexpected because three celebrities already passed away last week.

Does Billy count as the 4th celebrity to die, or is he starting the "death-trio" over again? We have already had reports that Fred Travalena, AKA "The Man of 1,000 Faces", and Gale Storm, from "The Gale Storm Show" and "My Little Margie", both passed away today. These two death could already complete the three started by Billy Mays. But then the question on everyone's mind appears - 'Who is Fred Travalena?' or 'Who is Gale Storm?'. What qualifies someone to be a 'celebrity'?

This is a question that I cannot answer. I think that 'celebrity' or 'fame' is defined individually. If I know who they are then they are famous (to me) and a celebrity (to me). Miley Cyrus is clearly a big celebrity today. However, I would bet that half of the people reading this do not know who Hanna Montana is or Miley Cyrus - I may go ever farther to venture that many people think they are two different people. And thus, fame is defined individually.

The theory that celebrities die in threes only works because we make it work. People die all the time, every day. But when some we know dies - we look for two more people we know to die. Before today I did not know Fred Travalena or Gale Storm, nor had I ever heard their names. If no other celebrities die in the next two weeks, then I will consider these two 'celebrities' to complete the 'trio'. However, if a more popular (by me) or more well-known (by me) celebrity dies this week, then that death will replace on of Fred or Gale's.

We want to make this work. We want the theory to be true. But why? Why do we look for death? Why do we expect two more bad things to happen after one terrible thing has already happened? Just to fulfil some theory that can never be proven. We should change the theory to "bad things happen in ones" and look for the positive events in our lives.

Celebrities Die in Three's

This is an old rumor that we have all heard. This week the rumor was fulfilled. Everyone time someone famous dies we all anxiously await the news of two more. Whether it takes a day, a week, or a month - it will be seen as part of the trio.

It is believed that this rumor started with the death of Buddy Holly, Ritchie Valens, and the "Big Bopper", when all three died in a plane crash. Since then there have been many trios of celebrity deaths:

• Buddy Holly, Ritchie Valens, & the "Big Bopper"
  
• Janice Joplin, Jimmie Hendrix, & Jim Morrison
• Don Knotts, Darren McGavin, & Dennis Weaver
• Princess Diana, Mother Theresa, & Gianni Versace
• Rodney Dangerfield, Christopher Reeve, & Ken Caminiti
• Johnny Cash, John Ritter, & Warren Zevon
• Brad Renfro, Suzanne Pleshette, & Heath Ledger
• Ed McMahon, Farrah Fawcett, & Michael Jackson

I'm sure there have been more examples than this, and someone could probably find debates within these examples - but the point is, that we think celebrities die in 3's. Everyone knows this can't be proven, and is just something we "look for". So, does it really happen - or are we just looking to make it work?

This is something that we do all the time - we force ourselves to believe things that we know are not true. For example, I first heard on the radio that Michael Jackson has "officially passed away". I didn't believe it was true until I saw it on NBC. Similarly, I make myself believe that my blood sugar is either high or low. This will make me eat more, or take more medicine. But I always know - in the back of my head - that it's not for sure. My body feels the same when my blood sugar is 480 as to when its 80. The only difference is what my mind is telling me. My mind is purely based on experience - but is that enough?

Honoring MJ

Today the king of pop passed away. This is a tragic loss to the music world but also pop culture. Michael Jackson helped to define the meaning of pop music and should be revered in a high regard. We will miss you Michael.

Sugar Sniffing Dogs

Researchers in England are training dogs to detect changes in their owners blood sugar levels. The study suggests that 65% of all dogs could accurately notify the owner when his/her blood sugar was low.

Full Article: http://www.msnbc.msn.com/id/31486267/from/ET/

It always amazes me how far we have come with diabetes & technology. But there is still so much more out there for us to discover.

Can't

This past weekend I was with some friends and we were discussing where to eat lunch. Someone suggested we go eat pizza. I said I wasn't in the mood for pizza and a friend piped in and said, "Stephen can't eat pizza."

This is when diabetes frustrates me. I can eat pizza, but I choose not to. Similar to a vegetarian - you can eat meat but you have a reason not to. Currently a large part of my control over diabetes relies on my diet and exercise. I don't use a pump or take 4 shots of insulin a day. I am taking one shot per day and controlling my meals with oral medication. This requires me to make better decisions and think about what I am going to eat. Now, I could eat a whole pizza with a coca-cola and a slice of cake - and I would be alright. My blood sugar would be high, but it wouldn't kill me.

I am having issues with the word "can't". I don't want there to be anything that I can't do. Today you can live a normal life with diabetes. I want to live that normal life, but often find myself stuck. I am stuck between forcing the crowd to make decision based on me and being apathetic about my diet. It is a difficult decision, and I don't have an immediate answer. But I think if "can't" doesn't exist in your mind in shouldn't exist in others. This is the problem that most people don't understand diabetes, its affects, and what you can/can't do.

Happy Fathers Day

If your father is no longer around - take a moment to remember and honor him.

If you are not a father - take a moment to congratulate someone who is.

If you are a father or have a father - enjoy today.

New Diagnosis

December 28, 2006 I was diagnosed with diabetes by my general physician. A week later I met with an endocrinologist in Atlanta to give a more detailed diagnosis and talk about treatment. I was formally diagnosed with Mature Onset Diabetes of the Young (MODY). The main reason for this was because I tested negative for GAD - this is an antibody that is present in people with Type 1. For the past two and a half years I have controlled my diabetes with diet, exercise, and oral medication.

My endocrinologist described Type 1 & Type 2 to me in basic terms. Type 1 is an autoimmune disease where your body destroys your pancreas. This must be treated with insulin. With Type 2 your pancreas produces insulin but it cannot get into the blood stream. He told me that my body was somewhere in between the two. My pancreas was not destroying itself but my body could not signal my pancreas to release insulin. I took a pill to signal my pancreas to release insulin. I managed this for 2.5 years. My A1C was between 5.4 and 6.0 for those years.

About 1.5 years ago I started going to a new endocrinologist in North Carolina. For the past year and half he has been waiting for the pills I take to stop working. His prediction finally became a reality last week. My A1C yesterday was 8.2. He has started me on a background insulin. I take one shot a day of basal insulin.

My body is still negative for GAD, but all other symptoms point towards Type 1. Yesterday I decided it doesn't matter if I have Type 1, Type 2, MODY, LADA, etc. Whatever the diagnosis is, it is still diabetes. As long as I have it under control that is what's important.

Whether you have Type 1, Type 2, Another Type, or you don't even have diabetes its still important to understand the effects and know how to manage them.

The Answer

Yesterday I met with my endocrinologist. My A1C was 8.2 - clearly I was having problems. He prescribed me a background insulin to inject once a day. I am excited to have something useful that can help lower my blood sugar, but I am not excited about daily injections.

More explanations/thoughts to come on this later...

"Light" Beers - Your Not So Good Friends

These beers are all advertised as "Light" but have significantly more carbohydrates than Low Carb Light Beers.

Beer	Carbs	Calories	% Alch
Bud Light Lime	8.0g	116	4.2%
Michelob Light	6.7g	113	4.3%
Busch Light	6.7g	110	4.2%
Bud Light	6.6g	110	4.2%
Coors Light	5.3g	104	4.15%

Low Carb Beer - Your New Best Friends

Beer	Carbs	Calories	% Alch
MGD 64	2.4g	64	2.8%
Michelob Ultra	2.6g	95	4.2%
Bud Select	3.1g	99	4.3%
Miller Lite	3.2g	96	4.5%
Natural Light	3.2g	95	4.2%

These are what I consider the Top 5. The most commonly available low carb beers.

When Moderation Fails

Moderation is one of the best tools in fighting Diabetes. If you can control your diet you can control your sugar levels. The fewer carbs that you eat, the less your blood sugar will rise. Moderation is great, but not always a possibility. This past weekend some friends came over to hang out by the pool and grill some hamburgers. Our dinner consisted of:

1. Hamburgers
2. Hotdogs
3. Baked Beans
4. Corn
5. Yuengling Beer

Unfortunately I was not in complete control of most of the menu. Typically I drink Miller Lite. Miller Lite has 3.2g carbs per 12 oz and 96 calories. Yuengling has 10g carbs and 145 calories. Not a huge difference (unless you drink the whole 12 pack). Also, we had white bread buns. I usually will eat whole wheat.

As a person with diabetes you can't just turn your nose up at the menu and say you're not eating. It may be appropriate for you to bring something for yourself, but not always. So what do you do? How can you be successful in a situation like this where you are so likely to fail? Everything on the menu is pure carbohydrates.

What I would do (and what I did) is to first try for moderation the best you can. I ate one burger, two hot dogs, beans, and corn. I ate the burger with a bun and the hot dogs with no bun. Unfortunately this still raised my blood sugar higher than expected. In these situation just realized that moderation can't cover everything. As long as you can bring that high back down you're alright. (And as long as it is not regular and you discuss it with your doctor).

When moderation fails your medicine steps in. This is why God invented doctors, insulin, and pills.

High Times

Last night I experienced one of my highest blood sugar levels - 433. Clearly this is not good. By the morning I had brought it back down to around 150.

I was diagnosed in December 2006, almost 3 years ago. I have gotten a pretty good handle on what I can and can't eat. But I am still learning. With diabetes you will learn something new about your limits everyday.

When you have the high spikes like this they are OK. As long as

1. it is not frequent
2. you can bring it down
3. and you can explain it

The rest is part of the learning curve. I promise you'll get the hang of it.


-- Post From My iPhone

The Hangover vs Old School

After watching the trailer for the Hangover I was excited and ready for the biggest and funniest movie of the summer. Unfortunately that did not happen. I went to see the movie on Friday with a few guys.

The movie was funny - don't get me wrong. But it was done by the same people as Old School. Old School is becoming a classic. All other comedies are rated based on Old School - "was it as funny as Old School?" I would have to say no - but maybe it will be better on dvd...

Everything is relative. We make most decisions based on comparisons. What is your diabetes compared to or relative to? Or what about your blog? There are 1,000s of diabetes blogs out there - do you stand out? The American Diabetes Association has already set the standard - can you be better?

Marketing Diabetes

Marketing Diabetes is something we don't think of very often. However, diabetes needs to be "marketed" or "sold" just as anything else.

Whether you are marketing for a company (there are many jobs on CareerBuilder & Monster), your blog, or just telling people you have diabetes - there are specific marketing strategies.

According to the American Marketing Association, 'Marketing' is defined as "the activity, set of institutions, and processes for creating, communicating, delivering, and exchanging offerings that have value for customers, clients, partners, and society at large." Basically marketing is just the presentation of ideas to others.

Here a blog dedicated to the marketing of diabetes. http://askelizabeth.typepad.com/weblog/diabetes/ (very good resource)

Market Norms vs. Social Norms

In yesterday's post I started to describe market norms and social norms. I left you with a question at the end. How do these norms affect you as a person with diabetes?

They affect us everyday! I follow market norms and expectations when using any diabetes supplies. It always runs through my head that each test strip costs around $1 without insurance and $.25 with insurance. When I don't get a large enough sample this frustrates me. I am paying a lot of money (relatively) for this thing to work and that "ERR 5" is just annoying.

Or think about the social norms you play with your doctor. Everything is going very well and you want a quick check up where the doctor tells you that you are healthy and one of his best patients. You leave the office happy for your new bill of good health. A week later the bill arrives. Since he is an endocrinologist (specialist) he can charge extra. Then you get an additional bill from the doctor's office (in my case my doctor works out of a hospital - I receive 2 bills). Suddenly the market norms are applied and we think the price is high for the relatively short visit we received.

Or maybe you volunteer for the Stepping Out walk for diabetes. You are willing to do anything and work all day for free without pay. You don't expect much in return - you just want to help out volunteering. Then think about that person that makes a large donation. He feels he is entitled to do whatever he wants to do on the walk. An expects to receive a T-Shirt, hat, and award after the walk.

When dollar amounts are involved it changes our thinking. This is the way everyone acts and it is difficult or nearly impossible to change. You should not try and act differently, merely notice the difference and expect people to act differently when money is involved.

Don't Expect Luggage To Arrive (DELTA)

During my trips for the past few weeks I flew to 3 or 4 different places on 3 or 4 different airlines. I started on United, then Airtran, and finally Delta. Each flight I took the airline charged $15 to check my bag. I was not very pleased about this, but it has become the standard for some time now. None of my flights were direct flights to my destination. I typically had about an hour layover between flights. This gave me peace of mind that my luggage would make it from the first flight to the second. On the United flight my luggage arrived no problem. On the Airtran flight my luggage changed planes with me. But on the Delta flight my luggage was "delayed".

There was study done by Behavioral Economic researchers in the United States. Many day care programs were having problems with parents arriving late to pick up their children. Behavioral Economics deals mainly with incentives. Why we make the choices that we make and how much you are willing to give up by making that choice. These economists wanted to solve the problem and create an incentive for parents to pick up their children. They decided to hold a 20 week study. The first 8 weeks they observed several day cares. On average there were 4 parents picking up their children late per week. They decided to then enforce a fine if the parent arrived late. The fine was about $3 per hour the parent was late (a very small fine). Suddenly the number increased. Now 15 parents per week were picking up their children late. They decided that this was not working and then took away the fine. Unfortunately this did not change anything - 15 parents per week still picked up their parents late. Why did this happen?

We have "Social Norms" and "Market Norms". Social norms are the culture 'rules' that we follow. Market norms are created when a cost is added. When there was no fee for the late pick up the parents were following social norms - they felt guilty picking up their children late. Once the fee was added the parents followed the market norm - it was now acceptable to pick up children late as long as you paid for it. This $3 fee replaced the feeling of guilt. Unfortunately once the market norm is introduced it may not be taken away. Parents did not go back and feel the guilt again because they had been taught that it was acceptable to arrive late.

One year ago Delta was operating on social norms. I expected my bag to arrive with me at my destination. However, when my bag does not arrive I give them slack - "I had a short layover" or "they'll deliver it to me for free". All of these things were acceptable and the free home delivery made up for the small amount of anger I had. However, they have recently introduced the $15 fee. This created a new market norm. I am now paying extra for this service. This fee removes any compassion or sympathy I may feel for the person responsible for making sure by luggage arrives. I now EXPECT my luggage to arrive. When it does not I am thoroughly upset.

All of this occurred to me as I was waiting in line to report my missing luggage. I thought about the new market norm that was created.

Do we create market norms in the world of health care?
Do you follow specific social norms because you have diabetes? How might you change those to market norms?

I will further discuss this in tomorrow's post...

New Domain - DiabetesCareNC.com

Today I registered the domain name DiabetesCareNC.com. I did this in hopes of creating a better site and reaching a wider audience.

The blog is still hosted by Google Blogger (http://www.diabetescarenc.blogspot.com/ still works). The RSS feed is still burned by Feed Burner. Basically, if you have any links or readers attached to this blog then nothing will change. The address is now shorter for you to find me.

In the following months I plan to expand the new site to much more than just a blog. I hope it can become a local resource to organizations and care (for NC) and a national blog (for you).

Thank you for your continued support, and keep reading!

The Culture of 99¢

Wendy's is know for their 99¢ Value Menu. Everyone knows that fries are on the Value Menu and that a drink is on the value menu. Then you assume that a small french fry or a small drink will cost 99¢. Unfortunately you are incorrect. Most locations will charge $1.29 for a small drink and $1.39 for small fries. Wendy's has actually incorporated four sizes: Value, Small, Medium, and Large. The "value" size is 99¢.

Wendy's is very upfront with their prices. The menu lists all prices in the store. 99¢ items are also advertised on TV, radio, magazines, etc. But they get you because they have changed the culture. In our culture "small" is the smallest size and the cheapest size you can order. You can't order "value fries" at McDonald's.

By creating this new size they are doing something interesting: they are starting a new Wendy's culture. When you order "value fries" you say the word "value" out loud. This triggers your brain to think of everything associated with the word "value". This could make you think that the fries are so good they are valuable. Or it could make you think that you are saving money because it is a valued price.

Wendy's has forced you to think this because you have to say the word value to order the fries. They have also created a new idea in your head. You normally associate small, medium, and large to fries. They have created a new association. Starbucks did the same thing by calling their drinks "tall", "venti", and "grande" (instead of small, medium, and large). This new association will only apply to Wendy's. And because you have nothing to compare it to you will pay anything for it. (This is one reason why you pay $1 for coffee at McDonald's and $3.50 for coffee at Starbucks - your willing because it's different).

A small french fry is 30¢ more than the value size. But what if McDonald's began selling "value fries" for only 59¢. Would you still want to pay 99¢ at Wendy's? No, you would be upset that Wendy's charges more. But since you have no preconceived prices attached with the size "Value" then you have nothing to compare it to - and will pay anything.

When you tell someone you have diabetes they already have preconceived notions about that. Similar to the expectation that a small drink will cost 99¢ you have to change that association. Create a new association. Create your own "Value drink" for 99¢. The person may think of BB King and the One Touch Ultra when they hear "diabetes" or they may think of death and disease. Whatever that association is, we want to change it and create a new idea. That new idea needs to be you and your personality. We want that person to think of you as a person instead of a "diabetic".

This may not be as easily accomplished as I make it sound. You have been trained to tell people you have diabetes. It's the truth. But next time you tell someone, don't just leave it at that. Don't wait for a reaction. Explain how it affects you, and that you have your blood sugar under control. Explain that you are not about to die, or lose a leg. Explain the disease, but also explain yourself. There is much more to talk about yourself that just diabetes.