Tag Archives: CGM

Too Trusting?

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(Second post of the day, I know, but I wanted to blog this in hopes to get some tips on how to boost my testing. What helps you remember to test?)

I absolutely love my G4 CGM system. The increased range is awesome (read: I have left the receiver in my car and forgot about it at night and ran back out to get it and it still had received my readings!) and the ability to wear the sensors has improved from an average 2 weeks for me to an average of about 24 days. And when you’re on a budget and knowing these sensors cost you about $75 each, you wanna make them last as long as possible. I can stomach an average of $3 per day verses $10. BUT, overall, the accuracy has been awesome for me. I know for some, it hasn’t, but with all things diabetes and bionic parts related, YDMV (Your Diabetes May Vary).

But looking over my meter, I think I’m trusting it a bit too much:

Meter Shame

It seems that I have taken a mental note as to how close my Dexcom matches my readings and have trusted it a bit too much. I’m barely making the 4x/day quota that I’m even supposed to check. I take for granted that the CGM is just a guide that it can can go awry and really be off.

I need to get back into the habit of checking again. Before and after meals. Just to have record of them, and to be sure my CGM is right. It’s sort of like the Double-check promise that some company had years ago that was to ensure that your order was right. I need to instill my own “double-check” promise.

I wish my meter would tweet it for me, so every time I checked, you guys could see and it would help hold me accountable. One can wish, right?

Change of Plans

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First, let me say that Medtronic has a good insulin pump. The features that it offers – bg-check reminders, missed bolus alerts, an optional CGM component, ability to see almost anything you’d want to see from any menu you have available in regards to basal, bolus, average bg, insulin on board, etc – are great. It’s also a very durable pump as I have knocked, dropped, and sat on the darn thing on not so soft of surfaces and it has held up. I have put it through the ringer, I promise, and it has proved to be a very durable, reliable insulin pump. My only complaints that I can find about it are 1) it’s only water resistant, not waterproof, and 2) there is no remote-bolus option – two things that are very important to me, but can be worked around.

The ease of ordering supplies either by phone or ON my phone via the myMedtronic app has been great. I’ve also had the pleasure of calling the reorder department about an order that I already had received but needed to change the set and they were able to do that. I don’t believe I have encountered any other company that works so extremely well with customers and getting the supplies they need.

Oh, and their customer service line? One word: Awesome. I never ever had an issue with them. I’ve worked with other companies that, when I encountered an issue, the problem would be placed back on what I had done or was made out that their product was perfect as is and it was obviously my problem (drip that with sarcasm). Granted, I have spoken with customer support before about my calibration issues with the CGM portion, and that is still something I cannot figure out why I can’t get right on a consistent enough basis, but they put up with me through it, making as many suggestions as possible, and even following up on my complaint later.

Which leads to my point of this post….

While I believe that Medtronic is a good company who has excellent customer service and a good insulin pump product, I personally do not choose to use the pump as a pump+CGM combo any longer. The issues of the CGM that I was beginning to have led to more frustration than I wanted to have.

Since the end of June, I started becoming more and more dissatisfied with the CGM and the requirements of calibrations for it. I tried everything and made a full honest effort to stick to the rules, but it just wasn’t working out for me. Granted, I absolutely LOVED that it is integrated into the pump. That part is absofreakinlutely the most awesome thing ever to have both a pump and CGM in one and not have to worry about an extra device to keep up with. Accuracy wasn’t too bad at all either as long as you calibrated as required. Most of the time, I’d say, probably about 80-90% of the time, it was almost spot-on or within the allowed 20% deviation range. The only time I had issues were when I either hit a bad bleeder, the sensor wasn’t all the way in, or if the area chosen was just not a good placement. I had a pretty good system of being able to insert it manually and cover it with tape in a way that prevented most of those problems, but sometimes it still happened.

After speaking with Erik over the past few weeks and with my endocrinologist, we have made the decision to switch back to the Dexcom. This was not an easy decision to make as I hemed and hawed, thought and thought, even made a spreadsheet to help me reasonably make a choice that would be the best for me and what I needed. The only reasons are that it seems to work better at following my low or high swings, the pain of insertion is not nearly as bad, and the sensor lasts 7 days. Granted, it’s a pain in the butt having an extra device to carry around as I’ve already left it at home a couple of times on lunch break, but I don’t mind it being separate over all. I also don’t like that I have to avoid Tylenol again, which was one of the biggest factors of the Minimed CGM that I loved other than integration– no Tylenol restriction!

This has not been an easy post to write. As a matter of fact, it has been in my draft que for days and gone through several revisions because even though I made the switch over to Dexcom, that does not mean that I believe any less in Medtronic’s products. I contemplated not saying anything at all, but I also know that as a blogger, I believe in honesty and disclosure to my readers. Things that I have blogged about in the past in reference to how I may or may not have liked the Revel system as a whole still are true, but reflect my feelings as of the date of the posting. Things change. People change. Our needs change. And the change from the Minimed CGM to the Dexcom is just one of those changes for me.

I haven’t totally given up on the Minimed CGM though. I still have supplies for it and if I want to hook it back up, I can. But I feel that right now, I have to do what’s best for me and my diabetes treatment and, most of all, my sanity. And who knows? Next year, hopefully when the Enlite sensor is out, I can try it out and I may switch back. Just depends on how it compares and how it works for me.

*************************************************************************************************

The past year, as mentioned in my Disclosure, I have been a blogger for Medtronic on their site, The Loop Blog. Working with Karrie, Amanda and the Medtronic team has been enjoyable as well as a learning experience. I am so grateful to have had that opportunity. The contract has ended, but I hope that the friendship can still remain. A few posts that have been submitted for review may appear later on their site (which is up to their discretion), and do reflect my view of the topic honestly at the time of the writing.

Breaks Are Good

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So it comes as no surprise that I was irritated yesterday. (Naaa, really, Sarah?? Never woulda thunkit! /sarcasm). I think the stress of finals this week in combination with the icky, sticky, messy heat, my allergies or pending massive summer cold, and the fact that I had gone through two sensors in two days for various reasons (and ended up having to pull yet another one last night too…strange gusher issue) had me to my breaking point and the second sensor pull had tipped the cap to my irritability.

But, on the advice of my new good friend, Scott E (yes, we have a LOT of Scotts in the DOC) as well as Stacey D, I have disconnected the CGM part of my pump for now. I don’t quite understand what happened last night, but I checked my site to be sure everything was a-okay (habit – a good one to have, mind you), and the air space inside of my tape all around my CGM site was filled with blood. Keep in mind, this was already a day old, so any bleeding should have happened within a few minutes of insertion, or so I always thought. I pulled the site and just kept it out.

I may stay on a break for a week or so…. or at least until after this week is over. I’m to the limit stress-wise with these finals, my baby’s upcoming BIRTHDAY party (Geez! Already!!????!???), and a few other things going on personally. I’m just worried that with my OCD-dBrain, I won’t be able to stand it and will have to reconnect to see the numbers.

Breaks are good……

right?

dTech Stress.

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I’m probably taking a risk here, but I need to vent.

I’m irritated.

I think my body hates me. My bg’s are all over the place – mainly due to stress and eating wildly (I tend to eat when I’m stressed, and lately I’ve been VERY stressed), I’m sure.

But most of all, my sites are being a royal pain – in – my –  tushie. I’ve tried the different sets. The only one that works consistently is the Sure-T needle ones. I hate that I can’t use the cool colorful ones anymore because my body somehow manages to kink them within a day.

My CGM sites? HA! I’m so mad right now I could scream. I follow my calibration times and rules. Yet, some last 3 days, one even lasted me 8 days recently, and others only last a day. TOTALLY irritating when you lose a whole entire day of inaccurate data that will be factored into your average that the doctor sees. I thought there was a correlation between where the sensor was placed and the accuracy… nope. Maybe between consistent calibration times? Better, but not really. Outside effects on the sensor? I can cover it and not let a wick of outside moisture hit the darn thing and it can still mess up, so no, that can’t be considered in it either. Not to mention they HURT like the dickens now too. I swear I’ve become more sensitive to them all of a sudden. What’s most aggrivating is that it seems that I have to follow just as much of a schedule to calibrate as when I was on shots for taking them. And isn’t that a major part of pumping? To be able to have lax schedules that fit your life?

Maybe I’m just going through a mental PMS and I need to just suck it up.

Of course, it’s probably because my bg is high right now too and it’s one of those that make me mad at anything.

But it’s good to vent, right?

I think it’s time for me to sit down and write out all of pros and cons to my current diabetes management system. Maybe I just need a break from d-technology for a while. I just don’t like the idea of it for fear that I will give up completely. Advice?

FridayFind 6 – Site Selector App

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(Sorry for not posting any this week. I had a problem with my site and some hackers and stuff, so I was working hard with my hosting company to get it back to working order. Now, on to my post…..)

Welcome to this week’s Friday Find! Several weeks ago, I was wanting to have an app that would track my sites – CGM and Infusion. Well, actually, this has been a dream for a few years now, but I actually started proactively looking for a way to make it happen. Well, unbeknownst to me, a good friend of mine – Brian Bosh (@Bosh) also had the same idea, but actually had the means and know-how to do it. He had developed an app called Site Selector. It was still in infancy stage, but I was so thrilled to see it and use it! I reached out to Brian with some suggestions of some improvements, and he worked hard on incorporating them. And now, I want to share a bit about it with you.

1. The app is FREE! Yup, FREE! Always a great point to make, right?

2. You can track both CGM and Infusion sites by long-tapping on the “body”, which will then place the site, or short-tap to zoom in on the area, and you can long-tap to mark the spot. A menu will then come up to ask if it’s a pump or CGM site, and then it places a dot for the site. Purple for pump, orange for CGM. It’s then recorded in the app and kept track of.

3. When you initially set up the app, it suggests healing rate times for sites, but as we all know, YDMV (You Diabetes May Vary), and some heal slower than others. You can change this to how fast or slow you think you heal. In doing this, it makes the app know how fast to “fade” the dots where your sites are to represent where they are in the healing process.

Pump and Insulin Settings

CGM and BG settings

Additional settings

4. It not only logs your sites, but you can also log your blood sugars in the Logbook section which can then be exported, but only if connected to your computer. But Brian gives excellent instructions on how to do this, and it works quite well.

5. With the reminders set, it alerts you as to when your current site has expired and needs to be changed:

Change Alert

As with anything diabetes-care related, you have to do what works for you. This app works for me because it can be as simple (only track CGM and infusion sites) or as complicated (those plus BG’s) as I need it to be. I absolutely love that Brian make it because I am a visual person, and being able to see where a site might be a no-no due to healing is a great help.

So, what are you waiting for? If you have the iPad or iPhone, go download it and give it a try! And, if you can, rate it for Brian so he knows how he’s doing. Or, if you have any suggestions, contact him at siteselector (at) alternateinterior (dot) com.

 

The Right Stuff

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I don’t know why this seems to be a “revelation” to me this week, but it has been. Blame it on the fact that I realize now that the reason why I’ve never been able to let my hair just “air dry” is because it’s wavy – I just have to put a little effort into it. But that effort is null without the right product. So, I’m on the hunt to find out the right product to emphasize and bring out that natural wavy goodness.

Cheezin

 

What does that have to do with diabetes? Everything.

We all know that diabetes is different for everyone (YDMV {Your Diabetes May Vary}), but everyone’s treatment is also different. It’s not a one-size-fits-all disease. Not everyone needs or wants to use an insulin pump, and not everyone wants to use shots all their life either. And those who do use pumps, there are many many many different brands. Where you might like an Animas Ping Pump, others might prefer their Minimed Revel {raises hand!}, or you might want to go “wireless” all together.

Some prefer not to have a CGM (why, I’ll never know), while others practically fight tooth, nail, arm, leg, and foot to have one. Some go with the “egg“, others either integrated into their pump or separate if on injections.

Some pull out measuring cups, spoons, weight scales and all manner of measuring devices for each meal to get spot on carb counts. {During pregnancy, I was one of these people. Anal, yes, but hey, it worked for me!} While others are fly-by-the-seat-of-your-pants SWAG {scientific wild a~~ guess} champions who eyeball foods based on carbs known in portion sizes… mostly relative to sizes of fists, palms, and thumbs.

All in all, you have to make your diabetes work for you. You also have to use the tools that work best for you. What works for someone else may not be what works the best for you. Research the options to their fullest extent. Ask yourself, “Will this really benefit me? Is this something I can keep up with long-term or is it just a “oooo, pretty!” decision?” And most importantly, keep in mind that the technology we have is pretty darn awesome, but it’s not perfect.

Now, off to research hair products.

 

My CGM Tips

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So, most of you know who have been reading my blog know that I am using a Minimed Revel pump + CGM for to control (or try to at least) my diabetes. Lately, I simply could not figure out what I was doing “wrong” with the cgm and why it wasn’t catching my lows or highs and things like that. I even posted a request on my DiabetesDaily blog asking for help from other Minimed CGM users as to what they do for more accurate readings. Well, after a week or so of buckling down to really try and figure this thing out, I have a few tips to share that may help you if you’re using the same CGM (or even a Dexcom – I’m not biased!). Of course, these are only tips that work for me. I am not saying you have to do these things, and as a matter of fact, I would rather you speak with your health care provider before trying these just to get the OK from them.

1. Undercover and overcover. (This one applies to the Minimed sensor – Dexcom users can’t do this one, sorry!)

After inserting a sensor, but before attaching the transmitter, put a piece of tape to cover the “sensor head” (the part that is purple-ish and flat), but under the “feet” of it. Take a piece of Tegaderm or IV3000, and cut it in half. Then, cut a slit in it that would look like your eyelid opening (just imagine this: () ). VEEERY carefully, slide the feet and connector end through the hole, so that part of it is under the feet and connector, but the other part is over and completely covering the sensor head, and secure it down.

Why do I do this? As an added layer of protection against water. I have found that if it gets wet and just a smidge of the sensor is above my skin, the sensor readings aren’t as accurate as they could be. Since I have done this, my readings have improved a lot!… but not as much as also doing this: (proceed to tip #2).

 

2. Don’t just let it get wet…. SOAK IT!

That’s right. Soak it. Overnight. If you put a reminder on your phone (or use the Medtronic app on your iPhone to remind you!) for the night before the sensor-change day. Insert a new sensor, secure it with the under/over cover method, and also with a total over-cover. Take another Tegaderm or IV3000 patch, cut a small square out of the paper that would be big enough to over the sensor, place it in the middle of the tape, then place the tape over the sensor. That way, you won’t accidently rip it out overnight or scratch it out (as I have done before). Then, the next morning, carefully remove the top layer of tape, and connect your transmitter, and add a final top layer of tegaderm to secure it and add that top layer of waterproofing. (Which, I have to say – the system is approved to be waterproof, but as I said before, I do it just for sensor accuracy for me.)

Sensor Change

Photo 1: Sensor under/over covered and covered for bedtime.

Photo 2: Carefully removed the top “sleeping protective” cover.

Photo 3: Connected the transmitter. Yey, green light!

The reason why I decided to do the soak it trick is because I noticed that my sensors (seeing as you only get 3 days out of these suckers) would be best  only on days 2 and 3. And, with me, extending the sensors just is not an option because I don’t get very good readings by day 5, so, I thought “hey, maybe let it soak and see what it does”. Well, by golly, it worked. And has worked ever since. (note: I also used to do this with my Dexcom, and it worked very well too!)

 

3. Log to calibrate.

I know it may be a hassle to do, but take one week to log everything – food, insulin doses (for food or corrections), exercise, etc, and find out your “quiet” times. The times when your blood sugar is going to be the most stable. Granted, yes, I know you Dexcom users are probably thinking, “Yeah, well, I don’t have to do this because I can calibrate at any time.”, and this is true, but trust me, it helps you guys too. Use these “quiet times” to calibrate your sensor. My times are (1) first thing in the morning, (2) mid-afternoon and (3) before bed. Your times may differ, just as your diabetes may differ from mine (to an extent). The reps will tell you to calibrate 4 times per day because though you’re required to every 12 hours (2x per day), 4 is the optimal amount of times, and more than that just gives it too much info. But for me, 3 times is a good number because it’s one more than 2, and one less than 4 – sort of the safe zone, so that it has enough information, but I have an extra “okay to calibrate” card up my sleeve as well for when it’s needed. And, if you are really, really, really a perfectionist about it (which, you’ll have to lose some of that perfectionalizm anyway to be any brand CGM user as they are NOT perfect), you can even set reminder alerts in your pump to go off at the times that are best for you to calibrate based on your awesome logging data.

 

So there you have it. I’m still working on other little quirks that may make it even better, but at this point, I’m pretty darn satisfied with the improvements I’ve had so far. And, if you have any tips you would like to share other than these, please – by all means, share them with me by leaving a comment. I would love some feedback from others who have some tricks up their sleeves too!

Technofail and Diafail

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Two words from the Diabetes Terms of Endearment that came to my mind this morning.

See, when I woke up at 5am this morning with Erik to get BabyK his bottle, I knew I was low. But I hadn’t been alerted because my CGM didn’t alarm. Why? Because it had “Lost (the) Sensor”. Ugh. I guess I had rolled the wrong way and it couldn’t get a signal. After checking my bg, and seeing the nice 44mg/dl come across the screen, I went into panic mode because it was then that I realized I was out of glucose tabs, fruit snacks, oreos, and juice. Lovely. So, I grabbed a glass, the milk, and the chocolate syrup in the door of the fridge. I figured, “hey, I don’t get chocolate milk very often, and I’m sure it will bring me up, so I’ll endulge thanks to this low.”. And I did. I probably lowbrainingly poured a full 2 – 2 1/2 cups of milk and squeezed a ton of syrup into a tall glass and mixed it and chugged. Then, I found two mini- moonpies in the cabinet… Not sure what flavor they were because they weren’t the classic chocolate ones… I’m not even sure of how long they’ve been in the cabinet either. I just know I was in a rage and ate those too.

Which I shouldn’t have.

And I should have known that.

But I was tired and I knew I had to get BabyK so Erik could rest a bit before getting ready and going to work since he had worked late.

So, this morning, I got up after taking a two hour nap with BabyK and got ready, took him to the sitters, stopped by to get my breakfast and then headed into work (I try to get in early so I can eat breakfast before starting work).

Keep in mind that my CGM had not alarmed this whole time, so I just thought that I must have either been dropping really low in the morning, or my pumping right after eating offset what would have been a high.

That is until I checked my bg….

387 mg/dl

I absolutely could not believe my eyes. This had to be a mistake. I don’t feel high at all. No dizziness, no thirst (other than my need for my morning caffeine), no pukey feeling, no getting up to pee millions of times until I woke up, nothin… zilch… nada.

So, I told my pump to use the number to calibrate and I bolused based on this number. Then I thought, “Oh gosh, what if it is a false reading?? Maybe I still have some chocolate syrup on my fingers from spilling the sticky stuff (I somehow managed go get it all over my hand, not just in the glass)!! I might have just over bolused! OH NO! Test! Repeat! Now!”

And so I grabbed my alcohol wipes, rubbed down, and checked, and while the number came up, I looked at the CGM graph to see what it “read”….

395 mg/dl meter vs 128 mg/dl CGM

Ummm. Yeah… so that answers why I didn’t get an alarm saying I was high when I hit 200.

Ugh.

Technofail… guys. This is why I’m scared to death of the artificial pancreas. I like having my CGM as a safety net, not as a main treatment device. Of course, it could just be my fault for calibrating while I was low, I don’t know. I like having the CGM integrated with the pump, but I would like a bit more accuracy than I have been seeing with it. It seems to not be as accurate as the Guardian CGM was, and that is kinda upsetting. Hopefully Minimed will work on a better, more accurate, less complicated (re: calibration restrictions!) integrated CGM + pump system, especially with Animas heading into the market with their Vibe soon (FDA, ARE YA LISTENIN’ TO ME??? PLEASE APPROVE THE VIBE FOR MY FELLOW DOC PEEPS!).  *Note: The CGM did correct itself after calibrating that massive BG.*

Diafail… Yeah, probably had some user error in there (lowbrain pantry rage, anyone?)… but I don’t remember having this “offness” with my CGM, calibration error or not. But for this high, I can’t blame the CGM. I should have never raided the way I did, and if I did, I probably should have had a “chaser” (quick bolus to cover a rage session).

*sigh*

I guess it’s just another day in the life with D.

Smile

(PS., It’s 11am, and I’m just now eating that breakfast I bolused for…. because now, I fear, I am plummeting….)

117mg/dl on Meter

First Solo Guardian Sensor Change… Sort of.

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MM SensorI had to do my first solo Minimed Guardian sensor change Friday, and I took the opportunity to take some pictures.

While I know there are ways to extend the sensor, my skin was getting itchy and sort of painful, so I decided it was best not to try my luck and go ahead and switch things out. After I got up and showered, I went ahead and placed the new sensor in my upper thigh, which, once again, gave me no trouble using the Sen-serter. (Shhh! I actually like the device! No gearing up to do a manual insertion – it does it for me!)  I made a make-shift Band-Aid to cover it using IV3000 and cutting a square to cover the sensor out of the paper and making a sensor sandwich to cover it (sensor, paper, then IV3000) but make it easy to remove and not pull the sensor out when I was ready to do the switch.

So, at around 1pm, I started to do the process of switching everything out. I was so used to Dexcom’s way of going into the menu to stop the old sensor and then start the new one when you were ready, that I went completely confused when I didn’t see a similar setup in the Guardian’s layout. I went back and referred to the manual and the online tutorial, but those ( I thought ) only applied to inserting your first sensor… not how to do a replacement “new” sensor. So what did I do? Yep – I called Minimed Customer Support and asked them to walk me through the process. I have to give them an A+++++ on this because the rep I spoke with was very understanding, patient, and very eager to help me and even double-checked with me to be sure I understood the process completely. He went above my expectations. He not only walked me through, but he made sure I understood the process well enough for the next change out as well. That’s what I call great customer service!

I knew that the area had been itching that night before and that morning, but I figured it was just about that time that I get rashes from glue adhesives and it would be fine as soon as I changed everything out. Well, when I took everything out and off, this is what I was left with:

Old MM Sensor Site

Not only did I have a rash from the glue, but somehow, my skin had been cut between where the clam-shell transmitter and the butt-end of the sensor meet. I’m hoping this won’t be a recurring thing with the sites and it was just that I had placed this one on my side. Granted, the user guide does state not to put the sensor in an area where your body moves a lot, so putting it on my side was not the best idea. But with being as pregnant as I am, we weren’t sure where to put the sensor during training since my stomach wouldn’t be safe right now, and I didn’t really want to strip down to put it in my leg either. So just a word of caution.. do what the book says… no insertion in “bending” areas!

BUT! On to the sensor itself. Setup went just as the first insertion. I recharged the transmitter, clipped it into the sensor that had been on my leg waiting for 5 hours by this time (I wanted to be sure to get it plenty “wet” and see if it helped with readings right off the bat), and tapped it down with IV3000. In the monitor, instead of having a menu option of “stop sensor” to stop the old one, you just go and tell the Guardian monitor to “start new sensor” and it begins the 2 hour warm-up period.

After the two hours, I calibrated and stayed pretty well on-track with no problems. I will say this though. Not only is it important to calibrate when your bg is steady and all that good stuff that they tell you, always clean your fingers. I know this should be a given, but I am very guilty of not making sure my hands are clean when testing. And how often do we fuss and complain about variability in CGMs verses meters when we’re probably testing with not-so-clean fingers? I know some of you out there are not as slack in that area as I used to be, but I have now made it a point to try to make sure I clean my fingers before testing, especially if that number is going to be used for calibration…. because what’s the point of calibrating if you’re going to give it a bad number anyway?

I’m scheduled for my second change out today. Debating on trying to extend it or change it. I’ll let you know on that one later.

Smile

And, just in case you wanted to see them, here’s some more pictures of what the sensor looks like (granted, this one is used, so please ignore the dried blood in places… I tried to clean it but some got left behind):

MM Sensor

If you look really closely at the sensor wire, you’ll see that it’s coated… I’m assuming that’s the difference between why you can take acetaminophen with their sensor and not with the Dexcom? Hmm.

MM Sensor

-Sarah

Minimed CGM: Experiences and Opinions Needed

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Hey you guys. Normally, I’m the one sharing stories and opinions of things. But this time, I’m asking for your stories and opinions.

Next week, I’m going to get a chance to try the Minimed Guardian CGM. I have heard various opinions here and there from different people regarding their system, but I want some feedback about the pros and cons of their system, and if you have or have had a Dexcom system, tell me the differences and pros/cons over the Guardian. You can either leave a comment or if you blog, write a post and link to it in a comment.

 

Examples:

Accuracy

Ease of use

Ease of insertion

Transmitter / Receiver communication

Comfort during use

Sensor life

 

Your help is very much appreciated!!!

-Sarah