Yesterday, I had my monthly appointment with my endocrinologist. I always look forward to my meetings with him – he’s always on top of everything to do with my diabetes, knows what a data nerd I am, and he fully trusts my decisions about my diabetes as much as I trust him to help me make decisions when I can’t.

He also knows that before my pregnancy, I switched pumps within my arsenal pretty regularly. He never had a problem with it. We even laughed about the amount of “backups” I have, even though all but one are out of warranty. When I received the second t:slim replacement in April of 2013 and started using it in January/February of 2014 after the cartridge recall and continued with it for a year until it was replaced earlier this month, he was impressed that I stayed with one that long. Last week, when I finally had enough of the craziness from my third replacement, he was willing to try to help because up until then, he (and I) was under the impression that I had found “the pump”.

So, when I went in yesterday, I told them about going to my Minimed once again (for documentation purposes), but this time I showed him the Dexcom reports between the two. He was floored just as much as I had been. Just as I had thought all along, he would expect to see that if I had switched insulin brands, not simply insulin pumps – because essentially they all should work relatively the same at delivering the set amounts of insulin. But the difference I had shown worried him. He told me not to use t:slim for the remainder of my pregnancy, and to stick to Medtronic. I had told him my husband and I discussed it and we had already planned to do that anyway, but hearing that from him validated it. And, in all honesty, it shocked me. He’s always been one to trust what decisions I make and go along with what I want to try, with the exception of ONCE telling me “no” to a medication I wanted to try, and this time I had the same reaction. He had stepped in and told me not to use a pump. Part of me is in shock, but partly not. It once again reassures me that he’s allows me to do what I want with my diabetes management, as long as it is within reason, and staying on a pump that would potentially cause harm would not be within reason, and he stepped in.

I will have add to all of this, though, that I did receive a call from Tandem at 10pm about replacing my t:slim once again. Since it is in warranty, that’s what I expect them to do. I went through all of the common questions they ask for record purposes, and the representative documented my answers. The replacement t:slim will be here next week, however both following doctors orders and for my own sanity, I will not be using it until the end of my pregnancy – or a bit later once insulin needs become somewhat predictable again. I’ll already lose some of my brain cells and energy to taking care of a newborn, and I won’t want to add switching pumps into the mix. He documented also that I wouldn’t be using the replacement until after August/September, so I wouldn’t be able to give feedback until then – and to my surprise, he didn’t try to pressure me into trying it any earlier. That made me feel very comfortable. I am glad that they reached out and were willing to replace the t:slim without hassle this time. I’ve only had a couple of sub-par experiences with their tech support, and the rest of the time it’s been good, so it does help to know that they are listening.

So, out of everything that’s happened this month, I am thankful to have an awesome Endo that I fully trust and that I know truly cares, and to know that Tandem does care – even at 10pm at night.

Usually, about once a month, I study my Dexcom trends and make minor adjustments here and there in my insulin needs (with permission from my endocrinologist, of course). This ritual then becomes a weekly thing during pregnancy, and this time is no different. And, later in the pregnancy, I tend to do this every couple of days or so due to all of the increased resistance and stuff.

Since I switched back to my Medtronic pump after issues with the t:slim last week, I wanted to get a good few days of data before making any changes since typically you do have to make some adjustments between insulin pumps. Not all of them deliver in the same manner (though relatively the same, but juuuuuuust enough to possibly need minor changes in insulin dosing). Here’s what I mean:

6 days on tslim 2

6 days on the t:slim I had been using during the first part of my pregnancy…

6 days on the *replacement* tslim... NO changes in rates as they're the same brand of pump so it shouldn't have made a difference...

6 days on the *replacement* tslim… NO changes in rates as they’re the same brand of pump so it shouldn’t have made a difference…

...and the last 6 days since being on MedT with practically the same rates.

…and the last 6 days since being on MedT with practically the same rates.

If you compare the first and the last picture, you can see that there’s not entirely too much difference, and the average BG between the two was only a few mg/dL off from each other. The replacement, however, was whacko.

Either way, I’m doing a lot better on the MedT and will probably stay on it. And since I have made that decision, it’s time to get down to fine tuning things. I’m dropping every night around midnight, and it’s taking longer to treat them, thus I over treat and go high. BUT, the thing is, I’ve not corrected those highs. I’ve been trending back down on my own. So that tells me I have some work to do between supper, bedtime, and overnight basals and other factors.

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I usually look at my trends on the computer and try to identify things. If I think I see something or have a hunch, I’ll print out the Daily Trends report so that I can see the days individually and not as an average, and I’ll write my basal rates below it. This time (for example), I noticed that I dropped an average of 57mg/dL from my highest average to my evened out number when I wake up, which, ironically, is close to my insulin sensitivity factor (55mg/dL currently). So, I took the 1u and divided it by the number of hours it had been dropping  before leveling out, which was 7hours, and it came to 0.14, which I interpret that to be a needed basal rate change of 0.15u per hour less than what I have it set at now.  It all may not be exactly right, as most of what I think I’ve figured out is simply a hunch that I try out and see if it works. If not, I have record of my information pre-changes and I go switch everything back to what I had before.

This the stuff that goes through my head while I’m examining my data. This is why having as much of my data in one place is as crucial as air to me, especially while pregnant. It’s such a pain in the butt to have to look at multiple reports and have to spend more time organizing it than actually analyzing it. So, I’ve also resolved to leave my beloved Verio IQ and use the Contour Next Link meter that works with the pump, so that all of my data from the pump and meter at least are in the same place. That, and since using the CNL meter, my Dexcom data more closely matches it whereas it hardly ever matched my Verio. I’ve done a lot of research over the past couple of days, and it seems that maybe the CNL meter is a bit more accurate than the Verio, and with the Dexcom using the more accurate 505 software, maybe the two are just meant to be… Or I could just be completely off my rocker. ;-)

So, I’m off to my endo tomorrow for my monthly checkup and to share my observations and changes with him.

(What I do and write here are in no way medical advice that you should ever take as such. I have worked very closely with my endocrinologist over the years and he has helped me learn how to do these things. If you want to learn how to manage and fine tune, please speak with your health care professional, as I am not one.)

 

Typically, when one such as myself who is a device hoarder and who likes change becomes in a medical state where circumstances would favor more stable device use and more concentration on what is actually going on, one would stick to those devices no matter what and create a harmonious data record flow throughout the medical state.

My said state is, of course, pregnancy. A highly regulated and controlled medical state in those who are diabetic because both high blood sugars and wide variations in blood sugar control can cause damage to the developing baby. So, when I found out about this one, I resolved to stay on my t:slim pump, Dexcom CGM and Verio IQ meter – both because I was happy with my t:slim finally after having used it for almost a year without issue and for the sake of keeping consistent records. I had no concrete reason to switch back to another pump other than for my own sanity as I still didn’t 100% have faith in it. In all honestly, even though I had used it for the entire year without issues, I still -in the back of my mind- wondered when the issues would arise again. I held my breath with each cartridge change and said a prayer that it would work just fine. And it did… until earlier this month.

Granted, I know that being in the second trimester that insulin resistance would start to kick in, but there was a HUGE difference in my control after I had received my last replacement from Tandem on the 6th of this month. I was right back to fighting wild, crazy numbers from all ends of the spectrum without any rhyme or reason to them – and the only thing that had changed was the pump. And while I could call Tandem about it and have them replace my pump again, I just don’t have the mental energy to go through it again when even this last time was a bit challenging to get it replaced because the error I was getting was not a known problem and the pump had passed all other safety tests. I’m sure for other people, Tandem is a great company. I think they have a good product on their hands, but for some reason I just seem to not have luck with it for long.

Last week, when I had finally hit my breaking point – literally, I was sobbing Wednesday while contacting my Endo and letting him know I would be faxing records to him for help – I decided to go ahead and use my Medtronic pump. Crazy thing is, just for my own security of mind, I had just had it switched out from the 5 series (the 180u pump) for the 7 series (300u pump) to have as a “just in case” for the end of the pregnancy when insulin needs were going to be much higher. One of the issues with the t:slim seemed to be when I filled it up to 280, it would screw with the load sequence – thus the reason I had it replaced. Within a day, my BG’s became predictable again. I could bolus without skyrocketing and plummeting later – as if the insulin wasn’t being delivered. I could pre-bolus on a predictable schedule before eating again. And while I don’t like that now I can’t upload my pump and meter together so all of my data is messed up, I’m more at ease about my glucose levels overall. All from switching a pump.

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Saturday, I put my t:slim into sleep mode and packed it up and away. I do not plan to use it for the rest of my pregnancy, and even after that, I’m not sure if I’ll use it again. I’m absolutely torn about it because it was the first pump since my Disetronic way back in the day that I truly loved to use. But it’s like I’ve heard many other veteran pumpers say – I don’t care how fancy you make your pump, I just want it to deliver my insulin and work like it should. Especially right now.

Of course, this all is not to say you shouldn’t get the t:slim if you want it – there have been plenty of people who have used this pump since it came out without issue. I seem to be one of the lucky few who has had problems with it. Not every pump works for everyone, and you can’t go off of one person’s experience to assume what yours will be. 

And I know this is already a long post, but I want to give a shout-out to my Medtronic rep if he’s reading. He’s been so supportive of me through the past 4 years – no matter how many times I would switch pumps and go back to my Medtronic one, he was always there to help with whatever I needed. I can honestly say that I have never had a rep from any company be as good to me as he has, and I really appreciate that. So, a huge “Thank you” to Travis, especially this time for taking out a few moments on your day off (and on your way hunting, no less!!) to bring me a few sets that I needed until my order comes – you’re an awesome guy.

On Monday, we launched a giveaway from PumpPeelz for the new t:slim Screen Protector/Peelz.

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Five lucky winners would be chosen from the comments that were left on the blog post and that time has come. So, without further ado, here they are:

#1 giveaway winner 1 giveaway winner 1 - Shannon

 

#2

giveaway winner 2 giveaway winner 2 - Susan

 

#3

giveaway winner 3 giveaway winner 3 - Alyra

 

#4

giveaway winner 4 giveaway winner 4 - Amy

 

#5

giveaway winner 5 giveaway winner 5 - Melissa

 

Congratulations to the winners of the giveaway!! You guys will be receiving an email from me later today.

And for everyone else, Scott and Emily have decided to allow me to give a discount code to the rest of you. During checkout, use Sugabetic10 to get a 10% discount off of your order! Yay!

Thank you all for helping to make this launch a hugh success!

I’ve been working with Emily and Scott over at Pump Peelz to try to create a way to make Pump Peelz for the Tandem t:slim. I already knew I loved their Dexcom Peelz as well as the ones for the Verio meter, so being able to add even more personalization to my insulin pump? Well, that would just be the icing on the cake to me.

A couple of weeks ago, they sent me a prototype to try out. I was ecstatic. I knew it was a potential product for them, but to actually get to try one out and see it in person was pretty awesome.

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What was even more cool about them is that they are actually screen protectors and designs in one. Yep. That’s right. Since the t:slim is a touch-screen pump, you do need to try to have something on the screen to protect it against scratches and things that can interfere with the touch sensitivity of the pump. With having the ink printed directly onto the screen protector, this allows you to actually change the screen protector and not have to layer a peel on top of your existing one thus probably losing it if you ever wanted to change the design again. (And, if your screen protector that you have on it now is in good condition, you can also carefully remove it and simply save it on a piece of wax paper or baking parchment paper for later if you’d like).

The ink and process that is used to make the designs is actually pretty neat. These are printed in layers with a 3D printer – one of very few in the country. They start out printing the white, then add the other colors on top. It’s done similar to how 3D printers print Braille.

The fit wasn’t exactly perfect in the beginning,

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but we took some additional measurements and we think we’ve got it right now.

Yesterday, they announced on their Pump Peelz Facebook page that they are ready to go, and I am excited to share this with you.

And, courtesy of Pump Peelz, I am also going to be hosting a give-away fro them! FIVE randomly chosen (with a number generator) commenters can win a Tandem t:slim screen protector Peelz! Just leave a comment below to enter. That’s it! We’ll let you know by Friday who the winners are.

Happy t:slimming! :D

In my last post, I talked about the possibility of maybe filling one of my pump’s insulin cartridges and simply changing my site mid-use. Doing this would save how much insulin I waste both in tubing and in that “cushion” of insulin that Tandem’s t:slim pump has since I’d only be throwing those out every 6 days verses every 3.

So, I started my experiment last week. I filled my cartridge up, hooked up, and hoped for the best.

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After 3 days, I got the alert to change my site. By this time, I was down to 155u, so I was right on track for the mid-6 day site change-out.

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Now, last night was the time when I get nervous because a) it was night time and b) I had 18u of insulin left. Looking at my pump though, I used only .9u per hour during the night, so I would have had enough to get through until morning. So, I got my little change-out bag together with my site, tubing, cartridge and filled the syringe and had it all ready to go.

I got to work and after bolusing for breakfast, my pump was down to 2u. By 10am, I looked and it said “1u”, but I knew it would alarm empty soon…

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And then it did…

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So. After 6.5 days, I was ready to change out again. Best part was, I didn’t have any decrease in glucose control throughout the whole process. Granted, once warmer days get here, I may need to go back to changing everything out every 3 days, but at least during the cooler months I know I can do this as an option.

(*read: do not take this as medical advice for yourself. this is simply stating what I have done and in no way implies you should do the same. always consult your health care professional before doing anything different from your current treatment plan.*)

Now, on to find an angled site I can use higher on my belly or on my love-handle area since this growing little baby is now starting to use my mid-section for a temporary home. :)

I was discussing with my endocrinologist this week about how much I love the t:slim and all of it’s features except for one of the main components – the cartridge with its “bag” design rather than a syringe. The reason being is that even though they may tell you that the average loss of insulin is comparable to that of other pumps, I have done my own personal testing (seriously – like, removing excess insulin out of cartridges and tubings and measuring them) and the t:slim, for me, does waste a significantly larger amount of insulin by the end of a month’s run. I know this may not bother a lot of people, but it bothers me. It’s, as my endo calls it, the Great Depression syndrome.

photo (12)I’m not typically a extremely wasteful person, but I’m not exactly the all-about-reduce/reuse/recycling person either. If I recycle, it’s because I’m reusing sturdy plastic cups from restaurants or water bottles that I’ve bought and refilled just to save from paying another $1.50 for water. But when it comes to my supplies and insulin, I’m very frugal. I cannot stand to waste. The reason being is because when I had my prior job, I had an insurance plan with a very high deductible, no offer of an FSA plan, and NOTHING, not even prescription medications (meaning insulin too) was covered until that deductible was met. During those years, I had to skip seeing an endocrinologist and simply rely on whatever stock I had built up, and when that ran out, I paid the full cost to see a doctor to get a script for insulin that I knew would last at least another year, and I didn’t go back and see him again. Of course, it all went against insurance, but even with all of these costs, I would have never met that deductible. So, throwing out a cartridge that I know probably contains about 40u of insulin even though my pump says “0” drives me purely batty. And I know, you can just simply recover it and use it to fill the next tubing and all, but remember, I have a very active 3 1/2 year old who barely lets me get through a straight-forward cartridge change now, so adding another lengthy step to this process, well, it ain’t gonna happen.

But I’ve been entertaining the idea lately of going only slightly off-label. See, the tubing and insulin that I use are both approved for up to 6 days of use. Only the cartridge is approved for just 3 days. I’ve heard of others who fill and simply change out their sites every 3 days, I’ve just not taken that plunge myself. If it works, I could at least save an extra tube fill (roughly 22u) AND cut the “cushion” of about 40 to a per-site-average of 20u. That would cut my monthly loss by a good bit, and I could handle the waste a bit better then. I used to do the fill-cartridge-every-6-day thing and change-site-every-3-days back when I had my Disetronic H-tron+ pump. It was what I was taught to do, actually. So doing it now shouldn’t be an issue other than hoping the insulin doesn’t break down differently in the cartridge. My next change-out will be tomorrow, so I’ll try it then.

“But what about the un-used tubing?? Won’t you be wasting that?” Yes, but I’ve also done some research on that. See, a few years ago, you could get split-boxes – 5 complete sets of tubing and sites, and 5 site-only sets. Apparently, this wasn’t cost effective, and really, in the end, it didn’t save the customer money at all. My thoughts are – a customer can reuse tubing (although off-label), but sites, once they’re done, they’re done. So, sites are the most important part of the set anyway, so why lessen the charge? Granted, it seems the only company that still recognizes that people like to change just the site at times is Asante because you can order the Conset infusion sets in split boxes since you shouldn’t need to change the tubing but – you guessed it – every 6 days along with your pump body. The sites are to be changed out every three, so you get 4 or either 5 complete sets and 4 or 5 site-only sets. Lovely, isn’t it? But, since their sets are proprietary and not Luer-lock, there’s no use pining over them. Besides, I could just save up all of that extra tubing and make some art with it for Diabetes Art Day too, so it won’t technically be wasted. Wish me luck!!

 

So, what about you? Any other frugal pumpers out there?

HAPPY NEW YEAR!… 13 days late….

So, apparently I have a thing now for only blogging twice a month? Well, rather than overwhelm with a very long post, I’ll just use some bullet points to bring out the most important things.

  • Diabetes is being rather weird. Some days, it seems I’m very insulin resistant, others I’m super sensitive. I don’t know if it’s simply diabetes being itself, or if pregnancy has a hand in it, or if my thyroid being wildy off recently plays a roll. Or it could be all three.
  • Speaking of the thyroid thing… my TSH came back above 5 on New Year’s Eve, up from a usual 1.3-1.5’ish. Not sure of the reason other than being pregnant, as this happened when I was pregnant with E, but either way, my Synthroid has been upped yet again, and we’ll recheck in a few months.
  • I’m now 14 weeks, 2 days today. Baby bump is in blooming, and while I’m excited, it’s also freaking me out. The whole going from one to two kids… The further I go, the more freaked I get. I’m sure it’s just a thing I’ll get past soon as my emotions are EVERYWHERE. We’ve also decided to go for an early gender ultrasound, so we’ll (hopefully) know on the last Saturday of this month. I’m excited.
  • School started back this week, and it will be my last semester. I have 3 classes left, two of which I’m taking this 8 weeks. After that, it’s one more 8 week class and I’m dooooooooooooone! Yay!
  • Lately, I’m getting frustrated with my Dexcom being really off. I didn’t have this problem before the new 505 upgrade, but it’s been more and more inaccurate. And, after reading Stacey’s post, I’m beginning to wonder if I may need to change meters. After all, it’s not a secret to me that the Verio isn’t very consistent when tested back-to-back. So I’ve ordered a Contour Next USB meter, which is supposed to work with Diasend (though not the Medtronic Link version of this), so I’ll update as soon as I know something… or at least within two weeks of testing and finding out things for myself.
  • Oh, and the news of Tandem’s t:flex gaining FDA approval this week was also pretty awesome as well. It’s their larger pump, the only one that can hold 480u per cartridge (but knowing what I know about my t:slim, I wonder if you’ll only have 430u available for use per cartridge since I tend to average about 50u loss per changeout). I think it’s great as I do love my t:Slim pump and have had a pretty good relationship with it over the past year or so since getting the whole bad cartridge thing behind me. I still hate the insulin waste, but on a daily basis and for my needs now, it fits perfectly into my “diabetic” life, and I’m happy with it. I can only be that much more excited that others who have needed a much larger capacity pump (some type 2’s, teens with type 1, and some preggo people) will now have an option to help them be able to use a pump without having to change out so frequently.

So, that’s about it. Not much going on, but a lot at the same time. I hope you all are doing well and are enjoying your January.

So my last post was about my little announcement and why I’ve sort of been MIA around blogging and stuff. As of today, I’m 12 weeks along and according to some places, I’m in my last week of my first trimester, and to some, I have 1-2 weeks more to go. Either way, I’m almost out of the first part, which I hope means I’m almost out of the whole morning sickness and fall-asleep-at-the-drop-of-a-hat part in the beginning.

The biggest difference so far between this pregnancy and the last one 4 years ago was that I am MUCH sicker this time around. I had a lot of morning sickness with E, but this time, it’s on a whole new level. It’s all day, which really isn’t that much difference, but it’s just much more intense. Chicken is my number one “no-no” food – I cannot bear to even think about it without feeling super sick, with any carbonated or flavored drink holding a strong second (yes, this mama has been without diet coke for 2 months now! shocker!). And, for at least one meal a day, I’ve resorted to having a Glucerna meal shake since the thought of any food at all is just not working out. I finally had to call and get anti-nausea medication because this time around, I’m very sick when I am below 70. And, since while being low, food is sort of important to keep down, I weighed the pros and cons and decided it would probably be more beneficial to be able to treat the low than the risks of taking the medication.

Other than that, my insulin levels by this time with E were dropping significantly and by the 16th week, I was at half of my usual dosages. This time my insulin requirements have dropped, but just not as significantly. In fact, they went up by 20% in the beginning and are now seeming to go back to pre-pregnancy levels. So, for the most part, that has been completely different.

My A1c came back at 5.8, after just a month before having it at 6.7. That was a welcomed result by both my endo and my OB. My OB had some harsh words at our first visit about how I am not the “poster child for a healthy pregnancy” (don’t worry, although I wanted to punch him, I refrained), but I think my endo may have had a hand in setting him straight about how OCD I am over my control, and our next visit was much different and his attitude had made a 180 toward me. My endo is just as attentive as he was last time, and we’re working on a weekly basis on my levels over fax and I see him once a month in person, with my next appointment being tomorrow. I have a feeling though, that with my cold that I’ve had over the past 2 weeks that my A1c won’t be quite so nice, but at least I have an explanation for it. I’m not too worried about it, but at the same time I am simply because I don’t want my OB to make some smart remark again.

Other than that, so far, things are going great. No issues or scares, and our ultrasound went great a few weeks ago. The baby was moving like CRAZY in there. E said it was “cute” and he wanted to hold it. It’s been an adventure trying to explain to him that there’s a baby coming next year. It’s also hard for him to understand why I can’t hold him right now too, which breaks my heart. We’re hoping that maybe once I start showing a bit and if he gets to feel the baby move himself that it’ll start clicking with him.

So, that’s my update for now. More to come later, I’m sure. :) I hope you all have a great and happy New Year!

Hi guys! Geez, has it really been a MONTH since I blogged here??!?!?? I can’t seem to wrap my head around that. I’ve been super busy outside of my blogging and social media world with trying to catch up and get ahead with school before going to the 2014 Diabetes Mine Innovation Summit near the end of November and then we had Thanksgiving and all of that lovely stuff.

Plus, I’ve not been really diabetes blog talk-y lately because anything surrounding diabetes surrounds something else that has been very important and prominent in my day to day life. Something we’ve not wanted to share until we thought it would be okay to do so… A little something that’s about 10 weeks in the making and will arrive in July of next year…

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We truly are surprised and excited. Everything I’ve thought about blogging about lately would include the pregnancy, so I hope you excuse me for being silent until we could find out for sure that everything is going okay.

I’ll blog a little more later about how things are going and how things are different from last time, but for now, I just wanted to get the word out! :-D