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Thoughts on the Dexcom Share Outage

Some background for those wondering “what’s a Dexcom?” and “why should I care about a ‘Share’ outage?”: Dexcom manufactures a popular continuous glucose monitor, or CGM, that allows people with diabetes who wear it to monitor their blood glucose levels in almost real time. It reduces the need for manual BG checks using a glucometer, provides advance warnings of low and high blood glucose events, and can interface with a popular insulin pump model to partially manage delivery of insulin. Dexcom’s Share server allows their CGM users to share blood glucose data with friends and family, so that others can remotely monitor them using a smart device. Share has been down for much of the Thanksgiving weekend, and to put it mildly, a lot of people are not happy. 

Online service outages happen, and the more essential they are to our daily lives, the more angry we are when they happen. We’ve come a long way from the days when the worst that could happen was a website going offline. Online services are more deeply embedded in our lives, and the consequences of outages are – or in some cases feel – more serious.

A couple of suggestions for Dexcom

Companies that deliver essential online services, and I’m looking at you Dexcom, would do well to remember two cardinal rules:

  • First, be clear with users about whether you are delivering a core product or a secondary service. As the anger over the outage spread, I began to think about the nature of Dexcom Share and whether it can be classified as one of Dexcom’s core offerings, or an add-on service that supports the primary product (their G6 CGM). The messages are mixed. It’s part of a very expensive product set (and I know – I just dropped a lot of money for G6 sensors and a transmitter), but it’s free to use. IMHO, anything that’s free – email, social sharing, etc. – is a crapshoot in terms of reliability. A paid service also comes with the right to complain when things go wrong. But here, we have a free-but-essential service. See the potential conflict?
  • Second, communicate in a clear and timely way. Look at the screenshot below. It says everything about the poor quality of Dexcom’s messaging, and the confusion it’s creating. The timeliness of updates on social media isn’t any better.

Rush to judgment

In the type one diabetes community, everyone’s journey is different. My experience as a person who has lived with diabetes for 43 years is radically different than that of the parent of a newly diagnosed child. I managed my diabetes for years without access to a glucometer, using pork insulin; new initiates to the diabetes community may have access to insulin pumps, CGMs, more sophisticated types of insulins, and other treatments, drugs and tools, including Dexcom Share. That’s their normal, and it informs how they deal with the disease. I may not necessarily understand the venom that’s directed at Dexcom, but I understand that it’s coming from a place of concern about loved ones and the feeling that something they depend on has failed them.

But here’s something that needs to the mentioned : Access isn’t the whole story. Tools to manage type one are expensive, and the majority of people with type one diabetes aren’t able to afford them. Relying on Dexcom Share implies that the user has a privilege that many can’t enjoy.

Many who enjoy that privilege took to social media to vent their frustration with Dexcom and assign blame for the outage. The frustration is understandable, but the conjecture wasn’t helpful or constructive. Suggesting that Dexcom doesn’t care about their users, isn’t properly staffed to deal with an emergency, hasn’t paid for reliable cloud infrastructure, and demanding a full accounting of what went wrong –while it’s being repaired – doesn’t solve the problem.

We all need to vent, but as a customer I’m more interested in knowing what went wrong and how the company plans to prevent it from happening in the future. If the answer isn’t satisfying, that’s the time to press the case with Dexcom and maybe consider moving to another solution. The latter step admittedly isn’t easy because of the few available CGM options, which is driving some of the online anger.

But if the tech is essential to keeping someone alive, venting is the least constructive thing to do in the moment. If there’s not a Plan B for a tech failure, health care providers can help. Facebook comments are a distraction.

This is going to happen again

There will be future outages. If not Share, with some piece of technology that lessens the burden of type one. I’m not going to offer advice about how to respond to those failures. My circumstances (pump/CGM user who doesn’t Share) are probably different than those of many reading this. But regardless of how you or I respond, everyone with type one needs to have constructive plan to manage the disease when technology fails. We can’t press pause while we wait for some piece of tech to start working again. We have lives to live.

Disclosure: I’m a longtime Dexcom user, but other than giving them a lot of cash over the years I have no relationship with the company. So I can say whatever I want, within limits.

I’m the Type

Earlier this year I collaborated with JDRF to create a video that highlights the type of people who ride and fundraise to support research into treating, preventing and curing type one diabetes. The video has been playing at JDRF Ride events this year, and I’m now able to make it available online.

Type One Diabetes and the Injured Athlete

I wrote this article for Heidi Armstrong’s Injured Athletes Toolbox. Heidi is a friend and tremendous resource for athletes who are struggling with the mental aspects of an injury.

This was my July: Recovering from a bicycle accident that left me with a broken clavicle and rib. Suddenly, I couldn’t ride my bike, and couldn’t run or engage in any of my other normal activities. A long, unhappy summer stretched out in front of me.

My recovery had one additional component: Type one diabetes, or T1D. I was diagnosed 42 years ago, and though I’m active, healthy and free of complications, T1D casts a shadow over the recovery process. Athletes with T1D can face distinct physical, emotional and spiritual challenges related to our disease. Understanding those challenges and learning how to adapt to them are essential to not only becoming whole, but maintaining health during the recovery process.

Those Pesky Numbers

Type one diabetes is a numbers game. Good health demands monitoring blood glucose (BG) numbers and the quarterly A1c, which provides insight into average BG numbers for the past three months. Regular exercise is a critical part of maintaining stable BG numbers within a target range. Athletes with T1D who are regularly active have a higher, more consistent sensitivity to insulin. This consistency removes some of the unpredictability about T1D from decisions about how to manage insulin, nutrition and activity.

Eliminating exercise triggers a series of cascading problems. Insulin sensitivity decreases; more insulin is needed to have the same affect. This can throw BG management off until the athlete recalibrates their bolus and basal doses to adapt to a lack of activity.

Athletes have to immediately adapt to this change in sensitivity following an injury. Whenever possible, they should look for opportunities to build mild activity into their recovery plans. Even a twenty minute walk following dinner can have a profound impact on increasing and stabilizing insulin sensitivity, and managing swings in BG. And, transitioning back to a normal training routine will be easier to manage if the athlete takes steps to stabilize insulin sensitivity.

Apart from keeping BG in range, athletes with T1D need to be conscious of other physical complications. In the case of my clavicle injury, keeping my arm in a sling placed me at risk for adhesive capsulitis, or frozen shoulder, a common complication from T1D. My recovery plan included progressive stretching as soon as I was able, to maintain my range of motion.

The Emotional Side of T1D

The emotional side of T1D is less understood than the physical side, but it’s coming into clearer view for those who study the disease. Athletes can see training and competition as essential to their health and well being. Take those things away, and depression and stress may take their place.

Both have a powerful impact on athletes as they navigate the recovery process. They also have a physiological effect on athletes with T1D. Stress triggers the release of counter regulatory hormones that increase blood glucose. These episodes can be intermittent or ongoing. Either way, they can lead to a roller coaster of high and low BG, complicating management.

How we manage the emotional side of T1D is as individual as the athlete. For me, focusing on interests that had been sacrificed to time on the bike and reconnecting with friends were two tactics that helped me manage stress while I recovered this past summer. More than distracting me, those activities felt productive and fulfilling.

Time in recovery gave me time to think creatively about new projects. Difficult as it was, when I realized that I would spend at least six weeks not cycling, I embraced the opportunity to do deep work that I had been putting off, and appreciated the value of having uninterrupted time to think and plan.

Like everyone who goes through recovery from an injury, I had my tough days. The best antidote for those was to rest on the couch with my dogs and read a good book. 

When an Injury Becomes an Existential Crisis

T1D is a chronic disease, and there can be a dark outlook associated with it. Those of us with the disease are aware of the possibility of possibly fatal complications, diabetic ketoacidosis , and life threatening hypoglycemia.4Injury can cause an athlete with T1D to suddenly confront, in a tangible way, evidence of their fragility and mortality. It becomes an existential crisis that threatens our identity as athletes and shakes faith in our ability to manage the disease.

That’s the spiritual side of recovery. Athletes with T1D can respond in several ways, including: Meditation or other contemplative practices, turning to faith, or despair. July and August were an opportunity for me to press pause on a busy life and use my time to be intentional and ask big questions about my goals as a cyclist and how the sport fit into my life. Even when a powerful sense of fragility was staring me in the face, I could look at the answers from those big questions and see a path back to wholeness.

Don’t Neglect Your Team

I’ve read here that recovery is a team effort. That’s particularly true for those with T1D. Injury brings the importance of having a team into sharp relief. I’m fortunate to have a network of athlete friends with T1D who I can call on for support, health care providers who understand and encourage my cycling, and family and friends who stand behind me. Having that team, before I ever needed them to help me though my injury, made all the difference.

Notes

  • Type one and type two diabetes are distinctly different diseases. For information about T1D read http://www.jdrf.org/about/fact-sheets/type-1-diabetes-facts/. 
  • A BG of 90-120 is a typical target, though this can vary depending on the individual and their activity. 
  • Basal insulin is either fast acting insulin administered in tiny doses via an insulin pump, or slow acting insulin injected once or twice a day. Bolus insulin is a single dose of fast acting insulin given to counteract food that is consumed. 
  • Diabetic ketoacidosis, or DKA, is a result of extreme uncontrolled high blood glucose. Hypoglycemia is low blood glucose. 

Ford and JDRF: Partners for a Cure

During the JDRF Ride to Cure at Santa Fe last fall, I was interviewed for this video highlighting the relationship between Ford and JDRF. Apparently the producers thought my hobo chic was a good look.

I’m riding again this year to raise money for the prevention, treatment and a cure for type one diabetes. Please consider a donation.

Perspectives

“Paris is a museum,” said the Paris-based filmmaker I’d been chatting with over beers.

Look beyond the monuments, museums, tourist traps, and other obvious must-sees and there’s vibrant everyday life. It may be a museum, but the people behind the scenes are fascinating to watch. It’s all about choosing your perspective.

The Perfect Travel Camera

2026 update: There’s a market for dead GRs, and I sold mine to partially fund a new GRiii. A review is coming.

2025 update: My GR bit the dust.

2024 update: My GR seems to be slowly dying, and the decision that’s on the horizon is, replace it or go for the GRIIIx, which has the 35mm equivalent of a 40mm lens. I’m straddling the fence on this one.

Let’s get this out of the way: There is no one, perfect travel camera. There’s only the best camera that works for you. Or in this case, the one that works best for me. First, some history.

I’ve shot with SLRs and DSLRs for about 40 years. In 2010 I traveled to the UK with a bag of Nikon bodies and lenses. I was shooting for a client, but I also carried that gear as I walked around London on my own. The images were good; the experience was miserable.

Three years later I was packing for a trip to Paris and looked at my big bag of gear. I remembered lugging it around for two weeks. Instead, I packed my Ricoh GR and two spare batteries.

The Ricoh GR, if you’re not familiar with it, is a wonder camera. For some people. It has an APS-C sensor (the same size you’ll find in many DSLRs), and a range of features that allow users to focus on making great images. The lens is a fixed 18.3 mm f2.8 (28 mm equivalent) that encourages getting closer to subjects. It also fits in a pocket. And that’s all I carried for a week and a half in Paris. You can see a few of the results below.

Since then, I’ve flirted with other cameras. My Fuji X100T often travels with me (and is a much better camera in marginal light), but I keep gravitating back to the Ricoh GR that’s been in my collection for five years. Here’s why:

  • It’s small and lightweight. The advantages of this are obvious.
  • That lens. It’s better than a camera at this price point has any right to be–sharp, with little fall off or softening at the edges.
  • Snap focus. If you’re familiar with zone focusing, this is essentially the same thing. When walking around I leave the focus point set at 1.5 meters (and aperture at f5.6); when I’m ready to snap a street pic the camera is already focused. There’s no lag. If I need to change the focus point I can simply press the AFL button on the back and it autofocuses.
  • Superb JPEGs. The internal processor is excellent, and I don’t have to deal with large RAW files. The resolution is high enough to print high quality 11″x14″s.
  • Custom settings. I have three custom settings that are changed on the top dial: Street color, street black and white, and square format black and white. I can switch between them quickly and without a lot of thought.
  • It’s unobtrusive. People around me often don’t notice it, and don’t have the same reaction to it that they would have to a larger, more “serious” camera.
  • It’s relatively inexpensive. I carry mine on my bike, and in situations where it might get beaten up. But it’s not so expensive that I worry about it. That way I can stick to the first maxim of cameras: The best camera is the one you have with you.

The GR has always been a cult camera, so much so that Ricoh periodically sighs (as much as a corporation can) and admits that there are enough photographers in love with the GR that it deserves an upgrade. The latest version is similar to mine, other than the addition of WiFi connectivity. But, there’s a Ricoh GRIII due early 2019 that’s going to be smaller and have a higher resolution sensor. The perfect camera, for me, might become more perfect.

Food Matters: Paris 2018

Following a recent trip to Paris, I have some new-to-us recommendations to add to my previous list:

  • Inexpensive and great seems like an oxymoron when it comes to Paris, but Raviolis Nord Est is on point. This hole in the wall near Les Halles offers salads and Chinese dumplings. Beth and I ate a filling, satisfying lunch for about 20 Euros. I recommend the octopus salad and pork and shrimp dumplings, fried. (1st arrondissement)
  • There’s a lot of buzz around Pink Mamma in Pigalle. They don’t take reservations, so be prepared to wait. After two hours cooling our heels with wonderful cocktails in their speakeasy (go down the stairs, then through the meat locker and a door marked “no entry”), we were led past an American woman throwing a tantrum (“I simply must eat here before leaving Paris!”) to our date with some burrata and a kilogram tomahawk ribeye. The food: excellent. The service: Warm and casual. The vibe: Way more hip than us. It made for a fun night. I’d go back. (9th arrondissement)
  • Get in line at Breihz Café. Be patient. Then enjoy savory and sweet Breton crepes. Have a mug of cider from a long list of good options. You won’t be disappointed. (3rd arrondissement, though there are also outposts in Odeon, Japan and Brittany)
  • We have it on good authority that Le Village is one of the last of the true Montmartre bars. I can’t tell you about the food, though the menu looked enticing. Instead, we had a beer (me, a Chouffe) and a cocktail (Beth, a mojito, which is in fashion) and spent a couple hours talking with a French filmmaker we met there. It’s an unpretentious place filled with locals. (18th arrondissment)
  • We liked Pizza Caratello so much we went twice. Don’t be fooled by the name–they offer much more than pizza. The first visit we started with a large serving of Burrata, then I had ravioli with figs and foie gras. The second visit I went for pizza (and more burrata to start); a Napolitana with fat anchovies and capers. Reservations aren’t necessary, though you might have a brief wait. Be patient, the food and hospitality are worth it. (18th arrondissement)
  • Huiteries Regis has been on my list for years, and I finally was able to have lunch there. Unless you love oysters, skip ahead. There’s not much else on offer. I had the menu #2: Six each of two varieties of plump oysters that taste like the sea, a glass of Sancerre and a coffee. If you do love oysters, it’s completely worth trekking to Saint Germain and waiting outside for one of the few tables. (6th arrondissement)
  • Hardware Société gives Hollybelly a run for my favorite brunch spot in Paris. It’s the Parisian outpost of a popular Melbourne restaurant. Long lines are the norm, though we lucked into getting a table right away. The coffee is sublime, and the mushrooms and poached eggs are perfect brunch fare. (18th arrondissement)
  • Overlook the sketchy neighborhood around Gare du Nord, and make a reservation at Chez Michel. It offers old school French cuisine and a deep wine list. I had fish soup with chorizo, croutons and parmesian; duck with mushrooms; and Paris Brest for desert. It’s my new standard for traditional French bistros. (10th arrondissment)

Reservations are still the norm, but English speaking diners will be glad to know many restaurants now offer online reservations. 

Tips: Better travel photos

No names, but I once sat through a slideshow of someone’s travels that included 300 images. About 50 in, I realized they had dumped their memory card and included every, single shot including those that were out of focus or blurred. It made for a long evening. 

When we remember our travels, we focus more on that experience than how we represent it to others. So we can gloss over too many pictures that show little or have technical problems. What’s in our minds overrides what’s on a screen.

A gilet jaune protestor at Place de Republique, during the winter 2018 protests in Paris.

So how do you level up your travel photography game? Here’s how:

  1. Start with the audience’s point of view. Remember, they may not have been there. Your photos are telling a story about the place and your experience. Let that guide you when you’re shooting and selecting photos.
  2. When shooting, find an interesting point of view. This usually means getting closer to your subject than you think you should. If you’re shooting with a camera with zoom lens, don’t use the reach of your telephoto as a crutch. Get close, then get even closer. Shoot the entire scene that’s in front of you to provide context, then focus on details that help tell a richer story.
  3. Edit. Ruthlessly. For me, this is a multistep process. First, I weed out shots with technical problems. Second, I quickly pick the frames that are worth considering. Third, I take a harder look at the first frames I’ve selected, and weed those down into a smaller set. Finally, I do some minor editing (color correction, cropping, etc.) and then take a last look at the set. Anything that doesn’t seem necessary goes into the reject pile. By the time I’m finished, fewer than 5% of the shots I took remain to be shown or published online. Often, the number is far smaller.
  4. Organize your shots. I like to present photos by theme, so they make sense to people who see them. 

What about gear? I’ll touch on that later, but for now think about process. How you work matters more than the tools you use. 


Fare wars

Christmas windows and skeptical bystanders

After a relatively slow summer for airfare sales, the last few weeks have seen competition heat up. Beth and I had a list of places we were interested in visiting this winter–Vienna, Amsterdam and Portugal were top of the list, along with Paris (no, we can’t quit that place). I kept an eye on fares, including tracking a few itineraries that fit timeframes that would work for us. We didn’t have to go anywhere at anytime, and decided that if the right opportunity showed itself we would make a decision.

That opportunity landing in my inbox a few weeks ago. Crazy low fares from Raleigh–a short drive from us–to Paris and return. We jumped on it and booked travel for our entire family.

Here’s the best part of the story: Earlier this year Beth had chosen to give up her seat on a flight to Chicago, and netted a thousand dollar travel voucher. Between that and the sale, tickets for the three of us were just over $300. Total.

I’ve seen even better deals the past week, from numerous airlines. WOW, which I’ve flown a few times, had round trips from BWI (Baltimore/Washington DC) to Paris for under $250. Super economy fares, for sure, but a few hours of less-than-stellar comfort could put you in the City of Lights during Christmas market season.

And fortunately the exchange rate with the Euro is still decent. That means our cost of traveling won’t be out of control, and we were able to book a two-bedroom apartment a block from the Metro, Beth’s favorite restaurant, and the only street in Paris for much less than a hotel. Paris for a fraction of the cost of a trip to New York, Chicago or many other US cities? Sign me up.

Pro tip: If an airline asks for volunteers to give up a seat, don’t jump at the first offer. Playing the waiting game can pay off. The offer for Beth’s seat started at $400 before landing at a much higher amount.

Food Matters: Paris

One of the pleasures of travel is finding good, local food. And one of my favorite cities for eating is Paris, thanks to an exploding culture of creative cooking that offers more than the sauce-heavy dishes that have long characterized French cuisine. You can spend a fortune dining there, but you don’t have to mortgage your home to enjoy a good meal. The places I love range from inexpensive to slightly-more-than-I’d-probably-spend-at-home, but every one is a good value.
  • La Table d’Aki is where Beth and I had one of our most memorable meals. Every dish–and they only serve seafood–is extraordinarily creative, and the wine list is simple and excellent. Two people, Chef Akihiro and an assistant, do everything from prep to cooking to wiping down the tables. Seating is very limited and reservations are essential. (7th arrondissement)
  • La Mascotte is a Montmartre fixture. Housed in a former hotel where Edith Piaf once lived, they serve a dizzying array of seafood. Here’s my advice: Start with a very good glass of champagne then go straight to les huitres (oysters), which are available from multiple regions and are presented by source and size. Reservations are strongly recommended. (18th)
  • Holybelly has the perfect breakfast, the Savoury Stack: Pancakes and bacon, topped with eggs over easy, served with home made Bourbon syrup. Oh, and their coffee…. (10th)
  • Le Severo is a serious steakhouse owned by a former butcher who has a keen eye for quality beef. We don’t spend a lot of time in the 14th arrondissement, but the trip to this small monument to steak is worth the trip. Trust the owner’s wine recommendations–they have an excellent list at reasonable prices. (14th)
  • Seb’on has an incredible reputation, and it’s only a matter of time before a Michelin star is bestowed on it. The creative menu changes nightly. The food is stellar and a good value to boot. Reserve a table well in advance. (18th)
  • Who travels to Paris to eat fried chicken? Me, that’s who. Ellsworth serves a typical Parisian lunch (entrée, plat, dessert–pick two or three) or you can dine on small plates in the evening. Their out-of-this-world fried chicken is available at either meal. If you skip the chicken (and you shouldn’t), there are plenty of other creative dishes on offer. (1st)
  • You’d never expect to find Babalou tucked away near one of Paris’s biggest tourist attractions, yet there it is around the corner from Sacre Coeur. They serve pasta, but the main draw is pizza with perfectly charred crust. Yes, it’s a pizza joint, but make reservations if you don’t want to be turned away at dinner. (18th)
  • Cave La Bourgogne offers French comfort food in a friendly setting. If you’re up for steak tartare, escargots, sardines in butter or a cassoulet, you can’t go wrong here. Bonus: It’s located on the wonderful Rue Mouffetard, which is perfect for people-watching. (5th)
  • Soul Kitchen is our first choice for a simple breakfast, though the vegetarian lunch menu always looks good. It’s a crowded spot that always seems to be full of moms who have just dropped their kids at school. I always get the same thing: A croissant with jam, fresh-squeezed grapefruit juice, and a latté. I never tire of this combination. (18th)
  • On a warm, sunny day find your way to Paname Brewing Company, on the Quai de la Loire, order a beer and some street food, and find a table on the deck overlooking the water. “Fine Parisian beers” used to be an oxymoron, but no more. This is a fun, friendly spot that serves excellent beer and food. (19th)

Pro tip for Paris dining: Reservations are the rule, and it’s good manners to make them and show up exactly on time. That said, many restaurants will do their best to create space for you if you show up and politely request a table. Starting with “Bonjour” or “Bonsoir” will go a long way toward breaking the ice.