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Two weeks ago I was invited, along with a handful of diabetes bloggers and advocates to Sanofi’s (third largest global pharmaceutical) corporate office in New Jersey on the eve of their launch of iBGStar. They secured FDA approval December of last year.

If you haven’t heard of iBGStar, it’s a new blood glucose meter that plugs into an iPhone or iPod touch. Using the iBGStar Diabetes Manager App it’s the first meter to work as a mobile health device. Shawna Gvazdauskas, VP and Head of Diabetes Devices, for Sanofi U.S. brought us together along with 7 members of her team to see the iBGStar up close and personal.

With the iBGStar (I is for  iPhone, BG blood glucose and Star their new line of devices) and its App, patients can record, track, manage and share their data, anytime, anywhere. The premise being that you always have your phone with you. I don’t, but I seem to be a minority of one.

The iBGStar captures blood glucose readings, records carbs and insulin doses, tags readings according to mealtimes and allows you to add customized notes about each meal or exercise. You can analyse the data using a logbook, trend chart and statistics. Color-coded screens indicate if blood glucose is too high or too low. You can of course show your doctor your handy, dandy phone, now turned into a mobile health device and/or email your results.

So, is this just moving furniture on the Titanic, or a real advancement for helping patients better manage their blood sugar? It all depends on you. But Sanofi’s intent, we heard, was to offer a device that “meets patients where they live and changes their experience of managing diabetes.” 

The meter can be used on its own, without the iPhone or iPod touch. It is the width of an iPhone as you can see and less than 1 inch tall, light as a feather, has a 6 second countdown, uses 0.5 microliter blood size, one of the smallest amounts, and meets accuracy requirements.  There’s no coding although that I would expect these days.

As a Sanofi rep said, “The hope for patients is maybe they will get more engaged with their numbers during idle time in the day. For doctors, a patient have their logs with them when they arrive at their appointment.”

Naturally, we all got to play with this nifty little device and walk away with one and 10 strips to see what we think. The only thing that bothered me was it consistently gives me a reading 20 plus points higher than the meter I've been using, the Bayer Contour. The thing is I don't know which is more correct, and you should know, if you don't, that meters are allowed to be 20% inaccurate. When I asked the question how does one know if the numbers you're seeing are accurate, the response I got from a gentleman on the marketing team is it's best to use one meter and get used to how it's judging your blood sugar. That's probably the right answer but less than satisfying.

If you’re wondering what these little meters cost and where you can get one, they're available at Apple and Walgreens retail stores and online at Apple’s online store and Walgreens.com. Apple charges $99.95 for the device along with 50 strips and Walgreens $74.95 with 10 strips. 

Sanofi offers a copay assistance card so strips will not cost more than $20/order. Sanofi also plans to integrate their GoMeals app with the iBGStar Diabetes Manager App.

It will certainly be interesting to see what other "Star" devices are in the pipeline.

Sanofi's Shawna Gvazdauskas, Brian Dolan of mobile health news, me, Emily Coles, Laura Kolodjeski, Sanofi Senior Manager, Patient solutions, Allison Blass of DiabetesMine, Kim Vlasnik of Texting My Pancreas.com, Kerri Sparling of SixUntilMe.com, Adam Brown and Kelly Close of Close Concerns. Blogger Leighann Calentine of D-Mom and analyst David Kliff of Diabetic Investor attended the meeting but had to leave before the photo was taken.

I took my weekly walk to Trader Joe this morning and as life sometimes serves up unexpected connections I found the woman behind the cash register has a son with type 1 diabetes. She told me reading the logo on the jacket I was wearing. 

He got it at three and is now fifteen. I felt our immediate bond as she packed my greek yogurt both smiling and looking apprehensive. She told me his A1C,  and her concerns. "How will he ever be able to take care of himself? I worry," she said. I was surprised, why wouldn't he be able to take care of himself? We find our way.

As I swiped my credit card she told me she's heard there should be an artificial pancreas in his lifetime and this would really help. I said with some confidence that I thought probably within ten years. Then she said, "but still I don't know how if he'll be able to take care of himself." As the eggs went into my bag, I heard her say "autism." I had missed it earlier. Yes, her son has type 1 diabetes and autism. My heart heaved for a moment.

There are many times I feel invisible with this disease. No one notices all the work I put in behind the scenes to stay well. Certainly no one in Trader Joe knew I had diabetes, including the woman now ringing up my sale, until my jacket started a conversation.

Before lifting my bag of groceries, I took her hands in mine. She said, "I hope it will be OK." I thought what can I say? I said, "I hope so too" and over a shared smile, turned and walked back into my life.

I relayed this story to my husband over lunch. I said, she must feel the same as me, unseen. How many people know her son has type 1 diabetes and autism? How many people know how hard she works to help him and her worries for his future? I wonder do her co-workers know? I can't imagine. 

In telling my husband this story he said, "Write it." And so I have. 

This is my full interview with Mark Sisson, health and fitness expert and author of the newly updated book, The Primal Blueprint.

Q: Tell me what the “Primal Blueprint” is in a nutshell?

Mark Sisson: For over 200,000 years, homo sapiens were hunter-gatherers living in “the wild,” eating plants and animals. For the last 9,900 years, our ancestors lived on unprocessed, whole foods, with few modern comforts. It’s only in the last 100 years that we’ve started eating industrialized, processed food and living sedentary lives. So, we’ve got 200,000 years of eating animals and plants versus 10,000 years eating grains versus 100 years eating mutated grains, refined sugar and vegetable oils.

The Primal Blueprint is a lifestyle whose tenets are informed by biological evolution, traditional wisdom, and modern science to form a healthy, sustainable, enjoyable way of being. It’s a way to eat, move, sleep, and simply exist with our ancient genes in this modern world - taking advantage of modern science and drawing upon lessons of our evolutionary background.

Q: You talk in your book about one being a “sugar-burning” or a “fat-burning” person. What does that mean?

Sisson: A sugar-burner requires a steady drip of dietary sugar - fructose and glucose - to maintain energy levels. So they can’t go long without eating. They burn basically carbohydrate and have difficulty accessing their stored body fat to use for energy, and in terms of weight loss, burn their fat. A fat-burner uses both their body fat and dietary glucose for energy and end up burning fat which leads to weight loss. Also, if a fat-burner skips a meal, it’s okay because he can run for days on his own fat (adipose) tissue.

Q: Even though our earliest ancestors may have eaten as you suggest in the Primal Blueprint, our more recent ancestors have been eating grains and beans for thousands of years. Have we not adapted to this way of eating? Asians were always thin eating their diet of rice and noodles, how do you explain that?

Sisson: Rice is the least offensive grain. It’s basically pure starch as opposed to something like wheat. It has no problematic lectins or plant proteins that interfere with digestion or disrupt satiety signals to the brain. In Asian countries they used to eat only foods like rice, meat, vegetables, all cooked in animal fat, and every day life was active. Now diabetes, heart disease, and obesity are on the rise because, like us, they’re eating more wheat, sugar, and vegetable oils and moving less. And no, our bodies haven’t evolved to catch up to our diet today.

Q: Most medical professionals regard burning ketones as a bad thing. The Atkins diet was criticized for that in the 1970’s. Yet the Primal diet depends on it. How do you answer them?

Sisson: They mistakenly equate ketosis with ketoacidosis. The former is a viable physiological way of burning fat for energy. It burns cleaner than glucose and spares necessary glucose for the brain to use. The latter is a pathological condition that occurs when insulin isn’t around to keep ketone production in check. Ketosis is a perfectly healthy physiological state to dip into from time to time. Burning ketones, which isn’t the same as being in ketosis, let alone ketoacidosis, is always occurring in a healthy fat-burner.

Q: I have type 1 diabetes. Making ketones has always been regarded as dangerous for people with type 1 diabetes. Is this diet viable for people with type 1 diabetes?

Sisson: Making ketones, which leads to ketoacidosis, only occurs when there is insufficient insulin present to regulate ketone production. Making ketones is different than burning ketones. As long as a person with type 1 diabetes is aware of this and manages this, there shouldn’t be a problem. I get a fair amount of feedback from people with type 1 diabetes who have had success implementing the Primal Blueprint.  And it can help with managing the disease. I would tell any patient to let their doctor know before undertaking any massive lifestyle change.

Q: Why do you believe eating Primal is the way we were meant to eat?

Sisson: I tried eating “the right way” for over thirty years and it nearly killed me. I was the paragon of fitness, a competitive marathoner and triathlete who ate whole grains and beans and watched my red meat intake. It didn’t work. Since I have always been a student of human evolution, I got my degree in biology, I started thinking about health in terms of nutrition and fitness. I did a lot of research and self-experimentation and trained tons of people, enough to realize that the Primal way of eating works. And I’ve found it works for just about everyone who gives it an honest try.

Q: What are people most satisfied with about the Primal diet/lifestyle?

Sisson: That it’s not a struggle, that its seems to come naturally once you get it. People like a lifestyle that emphasizes delicious, fresh, wholesome food, simple and effective exercise, lots of leisure and relaxation, good sleep and quality time with loved ones.

Q: Is there any scientific research to support this diet?

Sisson: Careful parsing of the nutritional literature is actually the basis of many of our recommendations, but there have been several paleolithic diet controlled studies. In one notable study by Lindberg out of Sweden, diabetic heart disease patients were put on one of two diets: Paleo (very similar to Primal) or Mediterranean. Paleo allowed no dairy, no grains, and had more meat, eggs, vegetables, and fruit than the Mediterranean diet, which was high in whole grains, legumes, vegetables, fish, margarine and low-fat dairy. Both groups improved, but the paleo group showed significantly greater improvements.

Q: What other eating approaches do you respect? And why?

Sisson: I like well-designed vegetarian diets. My wife was a vegetarian for years, still is, for the most part, except for seafood, and she’s one of the healthiest people I know. As long as you’re not eating loads of pasta, but eating actual vegetables and plenty of eggs and quality dairy, I think you can be very healthy as a vegetarian. I have dozens of longtime readers who are vegetarian yet make this lifestyle work for them.

Q: Conventional wisdom says soy, beans, whole grains and complex carbohydrates like sweet potatoes have a protective or positive influence, yet they’re not part of a Primal diet

Sisson: There’s nothing magical about beans or grains. They have no dietary monopoly when it comes to vitamins or minerals. Leafy greens, cruciferous vegetables, berries, and all the other produce we can eat provide plenty of micronutrients. Plus, many of those minerals in beans and grains aren’t absorbed. Phytic acid, found in most beans and grains, binds to minerals and prevents their absorption. Habitual grain eaters like birds and rats produce phytase, the enzyme necessary to break down phytic acid - but we don’t. So while those foods look impressive on paper, we’re not absorbing most of their nutrients. Traditional cultures that consumed grains and beans did so only after extensive soaking and fermentation, which improves the digestibility and deactivated most of the phytic acid. It also takes a lot of work and I’m just not willing to put forth that much effort.

Complex carbohydrates like sweet potatoes are not allowed on some paleo plans but they’re allowed on the Primal plan. Roots, tubers, and other starchy, underground plant organs can be an important part of your diet, especially if you’re highly active and need the glucose.

Q: How do you answer your critics like Dean Ornish who has scientifically proven that eating whole grains, and severely restricting the consumption of animal products and dietary fat reverses heart disease?

Sisson: Dean Ornish has “scientifically proven” that avoiding processed junk food plus daily meditation, stress-reduction therapy, regular exercise, and a cessation of smoking tobacco results in a slight, not a major, regression of narrowing in the coronary artery. The Ornish plan isn’t just the diet. It’s an entire lifestyle change. Stress, lack of exercise, and smoking are all causally related to heart disease, so you can’t focus on just the food.

I would agree with Dr. Ornish that removing processed carbohydrates, vegetable oils, and sugar is healthy. My program does all that too. I just disagree that removing animal products and healthy fat is a necessary component, and he has never proven that to be the case.

Q: Do you believe people with type 2 diabetes would be better served by this diet considering that they are three times more likely to have a cardiovascular event, and this diet emphasizes eating saturated fat?

Sisson: Absolutely. The last reviews of the medical literature have found that replacing carbohydrates with saturated fat does not increase the incidence of cardiovascular disease. Plus, this diet doesn’t emphasize saturated fat, it de-emphasizes toxic foods like gluten-grains and processed vegetable oils that are high in omega-6 and sugar.

Q: I have followed the Primal diet now for almost six weeks and find it takes extra time shopping to keep fresh produce in the house, and to prepare meals. Also, since I’m not a skilled cook, I find myself cooking the same things day after day. How successful have people been staying on the ‘Blueprint?' 

Sisson: It’s highly sustainable. A massive online community has sprung up around Paleo/Primal eating. In addition to my own cookbook, paleo cookbooks are being released every couple of months, and there are several dozen high quality Primal recipe blogs.

We post new recipes every Saturday and link to others every Sunday. To cut down on prep time, I would devote a Sunday afternoon to making a week’s meals. A big pot of stew, chili or curry, some parboiled vegetables, some sliced fruit, grilled meat that you can simply heat up or eat cold. If you plan and prep ahead, making your own food gets a whole lot easier.

As for produce, frozen vegetables are actually a more economical, longer-lasting, and often more nutritious option than wilted “fresh” produce.

Q: Do you know any cases where the Primal Blueprint hasn’t worked?

Sisson: I’ve seen people fail because they went too low-carb while trying to run 120 miles a week and train for a triathlon. Or because they went overboard with the “Primal treats” made out of almond flour, honey, and coconut oil, but I would say they were doing it wrong. I’ve never known anyone to fail when they removed processed, industrial junk food, started sleeping more and exercising better.

Book Review: The Primal Blueprint gives both an historical background on why we should be eating like our earliest ancestors during paleolithic times and why we’re now eating like our neolithic ancestors, and that our bodies haven’t adapted to many of these foods. Furthermore, many of the foods we eat today, especially grains, have been genetically and environmentally modified causing insulin resistance and inflammation, the root causes of many of today’s lifestyle diseases. The Blueprint in the book gives you 10 steps for reprogramming your genes to transform yourself from a sugar-burner to a fat-burner, lose weight, heal your body and boost your energy. Also, the Primal approach is not just a meal plan, and Sisson covers a life system including fasting, bursts of exercise and strength training, sleep and stress reduction.

What I like most: The book is written very simply and is a quick, easy and fun read. Men will probably also enjoy the cartoon-like characters Sisson uses to make some of his points. If you choose to try the diet, there is much support and more information on Mark’s blog, Mark’s Daily Apple. Mark’s written hundreds of articles about going Primal and provides recipes to help on the journey. I must also confide I like that on the Primal plan red wine and dark chocolate, in moderation, are allowed.

Weaknesses: Mark’s enthusiasm will tell you this is a simple diet and lifestyle, but for the average American it probably isn’t. There is some repetition in the book and at times not as much specificity, or scientific evidence, as I would have liked.

Take 2 and call me in the morning: With all lifestyle changes, talk to your health care provider before beginning this program.

Personal note: I tried the diet for six weeks. I felt fine and lost 2.5 pounds, but I found myself constipated. I then put some complex carbohydrates back into my diet like oatmeal and beans. Now I follow a diet in-between the Primal Blueprint and low-carb with some complex carbs and dairy. I side with those who say too much carbohydrate, not too much fat, is the cause of most of today’s ills including diabetes.

Spring has sprung. I'm looking at the tree outside my window full with pink and white flowers while I'm sitting at this computer writing my next book. It's going to be a small handbook of the key things to do to stay healthy with diabetes and lots of suggestions how to do 'em. So as I'm writing I thought I'd like to share one step with you for taking care of your diabetes. 

Collect Good Friends, Even If You’re Not A Collector 

If you’re planning on starting a collection, skip rare stamps, miniature toys, and vintage handbags, and head straight for the collection that pays dividends whether the market is up or down - good friends. Good friends don’t take up much space in your home and they’ll be there to cheer you when you’ve lost your cheer. Good friends say nice things about you even when you don’t, and they provide a shoulder to cry on when it’s all too much. 

Diabetes may from time to time make you feel alone; I know. But collect good friends and I guarantee you’ll find diabetes easier to live with. Plus, studies show that having friends, and strong social networks, can improve your blood pressure, memory and decrease physical ailments, cognitive decline, depression and Alzheimer’s. And don’t forget the biggest benefit of all - you’ll hardly ever have to dust them! 

• Let your friends know that you value them and schedule a get-together

• If you’ve been shouldering a lot of pain and stress, see if a friend would be willing to listen or help. Most people want to help others. 

• Do something new that you think you’ll enjoy where you’ll also meet new people - take a class, volunteer at your church. You’re very likely to make a new friend or acquaintance there. 

• Having friends who have diabetes is especially gratifying. Consider volunteering at your local American Diabetes Association or Juvenile Diabetes Research Foundation office. 

I don't know where I'd be without my friends, and I hope I never find out.

I'm part of a new service being offered by QuantiaMD called "Ask the Patient." I'll be answering health care provider's (HCP) questions about what it's like to live with diabetes, and how they can help their patients achieve better control and make healthy behavior changes. Given the strong emphasis on cut and cure in medical training and bare mention of behavior change, here's an opportunity for providers to understand how to turn on a patient's desire, skills, hope, and enthusiasm to take care of their diabetes. 

Here's my page which consists of a 3 minute introduction of myself, explanation of the service and a call for questions. After questions are submitted I'll my answers will be presented in a follow-up video.  

The service is available only to HCPs so patients will not know what you are asking. All you have to do is sign up.Members can access QuantiaMD for free through any smartphone, tablet or computer.  

If you are a health care provider, or know of someone you think this would benefit please pass this along. Having patient-experts as resources to help HCPs better understand what we deal with is to me a fantastic idea, and a brilliant way to help both patients and health care providers achieve better outcomes. 

Ask the Patient

A new doctor-patient relationship feature coordinating an active conversation between health care providers, and selected patient experts, exclusively on QuantiaMD. Through Ask the Patient, QuantiaMD is bringing the patient’s perspective on engagement, chronic disease, medical errors and many more topics to their community of clinicians. QuantiaMD is a medical learning network where HCPs connect with and learn from knowledgeable patients eager to share their experiential wisdom. On QuantiaMD, physicians learn about clinical advances from expert faculty and connect professionally to better manage their practices, support their patients, and take care of themselves. 

That's me, of course. Probably in my early twenties, just a few years after getting diabetes at the age of 18. This month is my 40th year with diabetes. I can't say if I ever thought I'd reach this point: I don't think I ever really considered it. I did think, however, how in the world will I read the little lines on my syringe when I'm old? Luckily at 58, I still have my eyesight. And better yet, I don't think I'm old, yet!

I wrote about my journey to here on the Huffington Post. Maybe another reflection when I hit 50 years!

So, the husband's in Holland where it's cold and dark and I'm sitting in Brooklyn this morning. (That photo's from our Christmas trip to Israel). Hmmm...some Valentine's Day you say? Well for me it is. It is the expression of the heart that just keeps growing fonder.

Yesterday I received my Valentine's email:

"I did an experiment," he wrote. "At 7:10 PM I checked my blood sugar (no he doesn't have diabetes, but he has a meter for occasional curiosity checks) and it was a perfect 85. I made dinner, vegetables and a veggie burger.  I sauteed it all in a wok with olive oil. I also ate 8 nuts. I finished dinner around 7:35 PM. [Is he anal? Not really. But he's a good researcher ;-)]

At 8:10 PM I took my blood sugar. It was 139. At 9:35 PM, two hours post-meal, I took my blood sugar again. It was 108.

I think in a normal person [he means without diabetes ;-)] blood sugar also fluctuates. Then it comes back to a set point. But even if you just eat vegetables and a plant-based veggie burger, no other carb, no rice or pasta, it shoots up. So if this pushes up blood sugar in a non-diabetic, then what you are doing as a person with type 1 diabetes, keeping your blood sugar so well managed, is near perfection!

And by the way, I HATED pricking my fingers!"

Yes, girls, to me that is love, and the perfect Valentine's Day card. The guy who four years ago went out in the midnight sun while we were on vacation in Helsinki, Finland to buy me a meter, is after 10 years of marriage still willing to prick his fingers for me.

Sanofi has created an extremely brief 6-question survey in a unique diabetes awareness effort. Until Feb. 12th by expressing what matters most to you about diabetes in this survey you get to shape the focus of Sanofi's Data Design Diabetes Innovation Challenge. 

The challenge will gather ideas for innovative solutions regarding diabetes awareness and care. After ideas are submitted, 5 semi-finalists will be selected for an intensive mentorship program, design boot camp and a $20K prize. Two favorite finalists will then be chosen by the public and finally a judge will select the winner who will receive $100K to develop their solution.

Sanofi is casting the net wide to grab as many innovative ideas, interventions and solutions as possible to help in the management and awareness of diabetes. On the survey page you can read all about the contest and rules. I should just mention winning ideas will be mentored by industry leaders, plus remain the property of their creator. 

So take the survey and help shape the Challenge. Be part of the solution finding a solution. 

Olly Neal

Nicholas Kristof

This was a wonderful story I read this weekend in the Sunday Review of the NY Sunday Times. It was written by Nicholas Kristof, Pulitzer Prize winning Op-Ed columnist. Nicholas Kristof is also an idealist. The kind of idealist I like. I've been reading his articles over the last few years and most are trying to wake us up to the genocide in Darfur. Once a year Kristof even takes a student and teacher with him on a reporting trip  to Africa to experience first-hand the strife and inspire in them their own way to make the world a better place. 

Kristof's Olly Neal article is filled with the same idealism and I like the take-away. The story is about how a teacher, Mildred Grady, ridiculed and reduced to tears by troubled and trouble-some student, Olly Neal, in the segregated South in the 1950s, ended up doing Neal a remarkable kindness that put him on a trajectory to become a lawyer, the first black prosecuting attorney in Arkansas and then a judge on the appellate court. The kindness wove its way to Neal's daughter who earned a doctorate in genetics.

I love being reminded that by being kind one can change another's day, and maybe their life. And I love that it's often a chain reaction. One kindness begets another. And, extending kindness brings its own joy. 

You owe it to yourself to read the whole story - and then pass it on, along with an act of kindness.

I came across this video while reading psychologist Arloski's blog on wellness coaching. 

It's about Dr. David Servan-Schreiber who succumbed to brain cancer almost twenty years after he got it. 

During Dr. Servan-Schreiber's years with cancer he inspired people who have cancer to fight for themselves through diet, being present and hope. 

I found the video moving and a confirmation of how much our bodies are the result of what we do. As Servan-Schreiber says, "Food is something you do to your body three times a day." The idea of food being something we do to our body was a different way of looking at what we choose to put into our mouths. 

You can substitute "diabetes" for "cancer" throughout this short video and I guarantee you will get something out of it. Even if just a reminder about how you're caring for yourself and your diabetes.

Thank you Dr. Servan-Schreiber. 

Saturday February 18th

If you have type 1 diabetes and could spend a Saturday hearing what’s currently going on in research toward a cure, and more – FOR FREE – would you? You can, and you are cordially invited to the second annual JDRF Type 1 Diabetes Research Summit.

Whether you are an adult with type 1, teen with type 1, parent of a child with type 1, loved one of a type 1, health care provider, CDE, MD, researcher, industry partner or interested party, the JDRF Capitol Chapter, which serves the Washington, DC metro area, is sponsoring this fantastic event Saturday February 18^th  in Bethesda, MD - and welcomes you.

Registration is still open but will begin to fill up, so don't put it off, and spread the word. Here's the full day's program. To register simply go here. 

While I wasn’t at last year’s event, I will be at this year’s. In fact, I'll be moderating the dozen stand-out researchers and scientists who will be presenting. Last year’s attendees numbered more than 400 and I heard via the grapevine all thought the conference was amazing. I know this year’s event will be just as amazing, enlightening and enriching both for what you’ll learn and who you’ll meet.

So if you’re in the area, plan to be in the area, or always thought you should see our nation’s capital, come on over, we’d love to have you.

A few scheduled presentations

• Targeting A Cure For Type 1 Diabetes – Kelly Close and Adam Brown, Close Concerns

• The Hope and Promise of Stem Cells and Cell Therapies – Juan Dominguez-Bendala, Ph.D, Director of Stem Cell Development at the Diabetes Research Institute

• Current Efforts To Prevent And Reverse Type 1 Diabetes – Desmond Schatz, MD, Professor and Associate Chairman of Pediatrics, University of Florida, Gainesville

• What We Still Need to Learn About T1D – Mark Atkinson, Ph.D, Director of the Diabetes Center of Excellence at the University of Florida, Gainesville

• Until There Is A Cure – Gary Scheiner, MS, CDE, Author and Founder of Integrated Diabetes Services

The Summit runs from 10 AM to 3:45 PM. There will also be a youth program for children five years and older and an exhibit hall featuring the latest in technology and resources.

Hope to see you there among our best and brightest thought-leaders and your fellow diabetes advocates and bloggers!