Changes At The Half-Way

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.

3 Weeks

Three weeks ago, I began what I thought would be just a break from my Minimed pump / CGM combo. I was constantly getting frustrated with CGM sensors not lasting the full 6 days (usually only about 4 days) and knowing that my records were going to be all messed up. I have to hand it to Medtronic though, they stuck it out with me the entire time and without hassle replaced boxes of sensors and even my serter. But with all of the trying and trying and trying, I just couldn’t get them to work. So, I wanted to take a break. Being overwhelmed with that and just everything else, I just didn’t feel like I could troubleshoot anymore. Now, I’m not saying their product isn’t good, because I know a LOT of people who use it and have had a lot of success too, but I’ve learned one thing – there is a lot of truth in the fact that not every device “fits” everyone, and no, they don’t all work the same. Thus, my theory that everyone should get to “date” pump systems before locking in needs to be a must. And I don’t mean just over the weekend. I mean like, for a whole month or two.  I just think with all the scar tissue I have and the sensitivity to the tape the Enlite has, it’s just not worth trying to make it work right now. So yes, in essence, it’s me, not them.

When I got frustrated, I switched back to using my Dexcom. Granted, it’s a pain in the butt to keep up with, but for me? The accuracy over the duration of wear time is much better. It wasn’t until everything happened with my eye that I realized just how important it was. I’m not saying it is super accurate, but I’ve been able to depend on it more than the pump CGM, and right now that matters a heck of a lot more than whether it’s integrated or not. Plus, I have no tape rashes or burns from the Dexcom, so that’s a huge plus for me.

IMG_5503Also, at the time, I had a fling. No, not that kind of fling… a pump fling. Knowing how I am about wanting to switch up pumps between the Medtronic and my t:slim, I had actually planned on going through maybe two cartridges in my t:slim pump at the end of March. I don’t know if the battery works the same as most computer batteries, but with those, if you don’t use them, the batteries mess up, so every now and then I wanted to be able to use it so that just the lack of use didn’t mess up the battery. So, when the eye thing happened, I was on the t:slim. I was not having any issue at all with the pump like I had before, so I am not attributing what happened to that, but I am telling you that because when I spoke with my endo, he told me to “keep everything to the same” until I went for my appointment… which will be next week. So, for 3 weeks now, I’ve been using my t:slim pump. Much longer than I expected, but I have to say, I haven’t had the issues with random, uncontrollable highs that I did before. In fact, it’s been quite the opposite. My control has improved. I still wonder if the cartridges I had were affected by the recall, but that the lot numbers were too “young” to be considered in it (my lot numbers were in the 300’s, the recalls started in the 800’s). I’m not going to lie, I’m sort of hopeful that maybe that was the case and now the pump will work just fine.

And, as an update to the whole eye thing, I have good days and bad ones. For the most part, if I can keep my blood sugar as steady as possible and without any major swings (like, no arrows on the dex, and no BG’s above 180-200 for a period of time), my vision is pretty well clear. But if I have a period of time were my BG has run high for a while or if I have major swings (like when I went from 220’s to 70’s within an hour and a half), my eye is pretty well good for nothing for a while. It’s amazing me how things work and affect us all. If anything, this has taught me, as I said before, it’s not about what you use to control your diabetes, as long as you’re using it the best you can and doing the best you can.

Anyway, that’s sort of a rundown of what’s been going on. I know it’s probably confusing when I just throw stuff out there at random without any true point or purpose other than to just get stuff out of my head, but that’s sorta what I started blogging for anyway.

Learning.

It’s been two months since I started on the #Medtronic 530G pump and #Enlite CGM. I have to say, it was something I fully expected to just be able to just jump into and use with no issue at all. Go ahead.. laugh… I understand.  While the pump’s operations are relatively the same (as far as bolus, basal, etc), the CGM is actually a very different thing than I remember the CGM being like with the old SofSensors.

Coming from the Dexcom and reading how the literature in the manual for the 530G’s Enlite was supposed to work, I thought it would be a simple transition, but there are some things that still hold true I’ve learned with the Enlite system. You do still need to have a schedule that you can stick to throughout the day to calibrate 4 times. For me, I find the best results come when I calibrate first thing in the morning, about an hour after that (so, when I wake up and then before I drive for work), at lunch, and then supper or bedtime. That, and making sure I don’t see ANY arrows ( I know the book allows for one, but I still don’t calibrate then) when I calibrate have helped tremendously.

One thing that Medtronic won’t… well… can’t (due to FDA) tell you is to explore other site locations. For me, my Dexcom was always a happy camper in my thigh. I never had issue there and it was out of the way. While my thigh would still be a good place for the Enlite, I have a very active (almost) 3 year old (GAH!) that I play with and he will inevitably knock the sensor in a way that would jar it and I would lose that sensor. For me, I’ve learned that my arms are my sweet spot for those. The problem is that it’s not always easy to insert there, and my hubby has to help me with it sometimes. Which, that’s okay because I’m finally getting full use out of the sensor and not having it zonk out after only a few days. For the past week and a half, I’ve had almost spot-on readings. Most of the sensor glucose values on my pump will be within 10mg/dL of my meter. And honestly, the amount even within 2 or 3 mg/dL have been uncanny. I’m hoping the trend continues and it’s not just because I’ve found a “sweet” spot for now.

Another hurdle I had to overcome was the taping issue. I’m allergic to the tape that they send so I had to find an alternative way to tape it. I know how to use Opsite pretty well and I don’t react to it, so I wanted to find a way to make it work. After trying various ways by myself and with the clinical nurse for Medtronic in my area, I think I have a solution… which is honestly nothing more than just buying the smaller 2″ width of Opsite (I had 4″ for my Dexcom sensors.. which was too wide) and cutting a piece the size of the Medtronic overtape, and cutting a hole in it similar to how the MedT overtape looks. By using that the same way you would use the supplied overtape and a thin long strip of the 4″ over the shell to hold it in place (since your arm isn’t flat, you sort of need something to keep the sides from catching on door ways, etc), It’s a pretty good system that has worked so far.

Most of all, I’ve learned to have patience with this system. If you take the time to learn it and don’t rush it, it can be used to your advantage. I’ve also learned that you can’t always follow everything exactly by the book. The instructions are meant to be there for the greater good of all of the customers as most are universal, but some things – like sensor placement and tape options – may have to be individualized…

and that’s okay.

🙂

Progress With The Enlite

On the 6th of this month, I wrote a post about how I was doing on the new Medtronic 530G system, and how things were going with the Enlite. I’m not going to lie, at the time of the writing, I was pretty upset that I had already used as many sensors as I had just trying to get one to last.

In that post though, I had one inserted at the time that had lasted successfully for 5 days by then. Well, I actually got a full 10 or 11 days out of it (shh!! don’t tell!) and was ever more excited to do so. The accuracy I had compared to my meter checks was almost spot on, and if not, it was within 10% or so. It wasn’t until the last day that I knew it was conking out on me and I had t pull it because the readings were terribly off and the ISIG value was very very low. Either way, I was able to get that one to last and get back the time I lost in the one sensor that got terribly kinked, so I’m happy with that. I hope to be able to get at least 10 days out of all of them if I can so I can extend them as much as possible. Granted, I knew going in that I probably wouldn’t be able to extend them as long as a Dexcom sensor, so I’m not terribly upset if I can’t. It’s probably healthier for my skin that way anyway.

It seems, though, that a lot of people have trouble with even the Enlite sensors, so I thought I’d offer a few things I’ve learned in hopes that it helps someone else.

1. Try to get your basal and bolus ratios worked out as fine-tuned as possible. If you’re someone who swings a lot (and I mean, like, a LOT), the sensors can’t be calibrated properly enough to give you good information. Granted, they’ve loosened up the calibration requirements (you can now calibrate at any time unless you have two arrows showing. I don’t recommend it, but you can if you have to)

2. Try other insertion spots. Yes, the Enlite is only FDA approved for your abdomen, but if you’re like me, you simply can’t wear them there. I have found my best spot is in my upper thigh area. It doesn’t get pressed on or knocked around at all, and the sensor stays pretty stable there.

3. Try inserting manually. I know, crazy, right? But it’s weird that the last sensor and this current sensor have been working so well, and yet I’ve manually inserted both of them. And really, it doesn’t feel any different than inserting a shot needle because of how thin the sensors are now. There are some videos on YouTube that show you how, so if you want to know how to do one, go watch those. I might do one later with the next insertion, I’m not sure yet.

4cartoon-clock-17420458. This has got to be the most important thing. Develop a routine for calibrating within your schedule. The calibrations you give is what it goes on to calculate your sensor glucose overtime in relation to the electrical current the ISIG signal is reading. So, for me, I found the most stable parts of my day, which happen to be as soon as I wake up, before breakfast (there’s usually a 1-2hr gap there), afternoon around 4-5pm, and then at bedtime. If I stick to this routine, I have better results. If it gets off during that time, I can still calibrate again in 20 minute intervals (usually takes about 3 to get it back in line at the most). Yes, this goes over the recommended 4 times max per day, but hey, if it works, go with it.

5. Never calibrate right when you test your BG and the pump asks you if you want to use it to calibrate your CGM. Always say “no” and then go look at your graph. See how you’re trending. That way you can make sure you’re not showing double arrows that could throw things off.

BG: 202 ISIG:27.28 (202 / 27.28 = 7.4) Technically I could calibrate, but I don't want to right now. SG is close enough to BG anyway.
BG: 202 ISIG:27.28 (202 / 27.28 = 7.4) Technically I could calibrate, but I don’t want to right now. SG is close enough to BG anyway.

6. Take some time to research what the ISIG is, beyond what the manual tells you. For me, it was learning how it relates to your trend over time. If your CGM is reading far off from what your fingerstick is telling you, you can do a simple math (yeah, I know, more math!) equation to see if it’s okay to calibrate or if your sensor is just being wonky at the time. (Of course, always wash your hands though if you get a wonky reading, since sugars and stuff from food can throw it off too.) If after washing your hands and retesting, the sensor is still off, take your BG and divide it by your ISIG value. If the value is between 1.5 and 20, then you should be okay to calibrate, though having a result that is closer to the middle of that range – between 8 and 13 – is probably even better. That means that more than likely the value you calibrate it by won’t be seen as erroneous and won’t throw a Cal Error at you. If it’s out of this range, try a few things like drinking some water, moving around or massaging the area (not directly ON the sensor, just around it – the fluid may not be moving around the sensor enough) for a minute or two and see if the ISIG changes in about 10 minutes. Also, if your ISIG is getting low, like around 4-7, it may be time to change the sensor out as no amount of calibrating will probably work.

7. Tape that sucker down. I know they’ve vastly improved the sensor taping this time around, and yes, you could go without using an over-tape, but I still use one piece over it just for security sake. It helps the sensor not to move or get jostled by accident.

8. I insert my sensor at night after the transmitter has charged (which I let it charge about 2 hours – no matter if the little light has stopped flashing), connect the two, tape everything down, and leave it alone until morning. When I wake up the next day, I tell my pump I have a new sensor in, and it usually asks for a calibration within a few minutes instead of two hours. This way, the sensor has soaked over-night and has settled in and has allowed any site trauma or irritation from a newly-made hole to calm down before giving it information. Also, this lets your first calibration come when you’re usually most stable, so you know you’re giving it a pretty good starting reference point.

9. Lastly, if I do choose to restart my sensor (if the ISIG is still “strong”… like, in the 20’s or higher), I carefully take off the tape while holding the sensor “head” still and then disconnect and recharge the sensor. After recharging, reconnect it and retape it. I do this at night so that I can calibrate in the morning just as if it were a new sensor. Then, just start the “new” sensor, calibrate and go. If you choose to restart the sensor, keep a closer eye on the ISIG as usually after a restart is when the sensor will start losing life. Some have made it a whole other 6 days with it, some only get a few more days (like myself). But if readings start going really wonky, check the ISIG (just the one on the pump, not the math equation thing). As I said earlier, if it’s getting low, like, 7-ish or below, you’re probably losing the sensor, so toss it and insert a new one.

I hope these help and not have your mind blown. I will say though, I’ve been very satisfied with their new system. In fact, I’ve not missed my Dexcom at all, and that’s pretty huge for me to say (which I’ll go into that stuff in another post.. this one is already a novel.) If you have any questions, feel free to ask in a comment and let me know.

First Impressions of the 530G

While I’m not officially using the pump and CGM to it’s full ability, I wanted to shed some light on how things are going so far in the 530G pumping world.

As far as the pump functions go, I really don’t see much difference between the 530G system and the Revel. There are some minor changes throughout the system, but overall, if you’re used to the Revel system, then the pump side of the 530G will be no surprise to you. I’ve been using it since I got it as a pump system, and haven’t had any issues, save for a motor error, which after a long trouble-shooting call with Medtronic, deemed it unsafe to use and I had a replacement by the next morning (and a Saturday morning at that, too!). Transferring information over from the Revel to the 530G was super easy to do, and once I did, I packed up my Revel and sent it in for the credit on the upgrade cost.

IMG_6853The biggest upgrade with the pump is the CGM component along with the Threshold Suspend feature (which I will refer to as TS from here on out). The new sensors have a new device that hides the needle, and it inserts at 90 degrees instead of a 45 degree angle. The sensors are much thinner and honestly, feel no different than an infusion set going in. That was my biggest complaint with the SofSensors was that they hurt like the Dickens (what does that mean, anyway?) and out of the three day wear, I would only get one good day. The new sensors are touted to be much more accurate than the SofSensors anyway, but time will tell. I know there are studies out there that prove they aren’t as accurate as the Dexcom G4, and I have to agree – but only on the basis that getting one to actually last 6 days has been troublesome.

I have used 4 sensors so far, and three of them have failed. One was inserted into my abdomen because, you know, that’s the FDA approved place… but what wearing a 35 pound toddler on my hip/stomach sort of throws that out of the window because, honestly, you have to be sensitive with these sensors. When I pulled it out, it looked like an accordion. IMG_6854The next sensor looked great, but it died after 4 days. The third one died after one day. No amount of calibrating, not calibrating, protecting it, restarting it, nothing, kept that sensor alive. When I called in to see if I could have at least two of them replaced, they went through and troubleshooted (troubleshot?) a few things with me, and basically, the sensor is delicate, and needs to be worn where it won’t get knocked or pressed. And really? Who thought that would be a good idea? People are active and we don’t want to have to worry about babying a sensor device. I could be all sorts of rough and tumble with my Dexcom and didn’t have much issue at all. Finding such an area on my body that won’t be knocked by my son or pressed on when I sleep or sit is hard. But, with this last one, I may have found a good one because I don’t sleep on it and I can be more conscious about my son hitting/sitting on it. It’s on my upper thigh, right were my pocket is. I also learned (from YouTube) how to manually insert a sensor (hence the ability to take the picture of the contraption, less the pedestal in the above paragraph), so I’m not sure if that had anything to do with it or not, but so far, this one has lasted just over 5 days, and with incredible accuracy. My only wish is that they had kept the idea of a slanted angle insertion verses the straight in. I think it causes the sensor to be more vulnerable to kinking and accordion-ing, which makes me nervous.

As far a the new CGM insertion device goes, it was relatively simple to use, but you had to pay close attention to how you used it. My advice here is to just play with it a bit and watch it from the underside so you know what happens when and how you press the green button on the side. A VERY good video on how to use the inserter and insert an Enlite sensor is on YouTube as well. The nurse explains it very nicely and in an easy to understand manner.

I’m honestly not ready to use the TS feature yet. I did try it out and it did seem to work okay, but I quickly turned the feature off. As I haven’t been trained on it (nor the sensors, but inserting and using a sensor is a lot different in my mind than using a function on a device that could cut off my life liquid) and I have a lot of questions about it.

I am excited about this pump/CGM upgrade, even if I don’t use it for what they are calling it to be (Artificial pancreas? nope. But we won’t go there). It’s been nice not to have to carry around my Dexcom with me. Granted, the alarms on the Medtronic pump is irritating to say the least, but I’m glad they are because I won’t ignore them.

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I may come back later after I’ve used it and give a more in-depth view of it, and if things are going successfully, I’ll leave some tips that have helped me.