The Right Stuff

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

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

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.

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

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

Just when ya think ya got it, ya don’t.

I feel terrible. I am just getting started with this blogging adventure of mine, and already slacking off. But not without good reason. See, for the past couple of weeks I have been sick. So, no, I didn’t intentionally take a cyber vacation, I really didn’t. But I am better now, so I am going to try to be better about my blogging (and twittering!).

Through my sickness, I promised myself that once I got better, I was going to stay away from Tylenol containing products as much as possible. See, having a CGM is a wonderful thing, but not if you have to take Tylenol because the doctor didn’t listen when you said you couldn’t take pain meds containing acetaminophen. I was trying my best to avoid taking it at all cost because Dexcom’s sensors don’t play nice with it. Since getting the CGM, I have been able to see trends in my bgs and act on them, change a few basal rates, and get most of my readings under control. Now, I was excited to be able to chart the effects of being sick as well. But, true to form, within 30 minutes of taking the pain meds, I got the (???) code on my Dexcom receiver. I shut down the receiver so that I wouldn’t have to worry about it trying to get readings while I was on the meds at night (they were prescribed only for night, but eventually, it became an all day need too), but that didn’t work. So, for over a week, I was flying without my CGM. It is the weirdest thing to go from being in the dark about your glucose (outside of a few finger sticks per day), to having this wonderful thing given to you to help you control your bgs, only to be so hooked and reliant upon it within a few weeks that you panic to be off of it for a few days. So, I figured that since I almost had my basals and ratios figured out, I’d be okay without my new little friend by my side. Well, I was wrong. I had more unexplained ups and downs than I could think of. Even now, I am off all of the medication and back on the CGM, and guess where my numbers are? They are great at night, but now, during the day, it is teasing me by bouncing around the 200 line, whereas before I stayed between 80 and 100 during the day. I have finally doubled my basal to get it down to the 140 range. I am just as lost as I was when I first started.

My biggest hurdle to overcome with diabetes is that there isn’t any set in stone rules to follow. Just because your plan worked before, doesn’t mean it will work now. It’s not like a recipe on a cake box. You can eat the same thing, drink the same thing, and do the same thing every single day of your life, and each day will never be the the same. You work and work to figure out your personal diabetes pattern, and just when you think you’ve got it, you don’t. Two plus two doesn’t always equal four. Each day is a new equation, a new bowl full of ingredients to make a new cake… only without specific instructions. The only instructions you have are a pile of past experiences to rummage through and hope that they can help you this day. And, yes, there are days when your cake will fall flat because it all didn’t add up or mix well, but you go back the next day and try again. Another day, another cake. But, you can’t give up, because the days when the cake turns out great helps to make up for the days that they didn’t.

Starting to color with my Crayolas

double duty Today marks the day that I started using my Dexcom Seven+.

I can tell you that I am honestly like a kid at Christmas when waiting for this kind of thing. Last night was terrible. The minutes and hours just seemed to DRAG by. Even today, the time between 8am and 1:30pm was SO long. I do declare that time pauses for those in anticipation just to pick at us.

My trainer turned out to be a really a nice lady. She actually explained that her two daughters and her husband all have type 1 diabetes. They all use a Dexcom and her daughters are currently on shot therapy for a vacation from the pump. After learning this, in a way, I looked at her differently. She doesn’t just sell this product, she uses and sees this thing personally with not only one person, but three. I took her advice more to heart with different tips she gave me.

Anyway, the time went by with the trainer very fast. She started off explaining the Dexcom receiver to me. I know it’s her job, but I had already read every bit of material they had sent twice or more and played with the receiver to set alarms (I know, that’s a no-no, but I couldn’t help it!!!) Then we got down to business. We got everything set up with the insertion device, got the Skin Tac placed, placed the insertion device right where it was needed. I pulled the safety latch out and got ready to push the plunger, and I wimped out. ME! You’d think after all these years of poking needles in me, I wouldn’t be nervous. Then, before I knew it, she pushed the plunger and it was in. I am here to profess to everyone of you who is reading this, I AM A DOWNRIGHT, HONEST-TO-GOODNESS CHICKEN!!! I felt so silly after it was in and all was done that I was that scared of it.

It was activated at around 2:30, so by 4:30, I should be able to do my calibration entries. Then I should be able to see my trends come up.  I’ll be starting to color with my Crayolas! How cool is that?!?!? I’ll write later and post some pics of my trends later.

(OH, by the way, for those of you who remember the A1C countdown blog, I officially have 5 days left. My appointment is Monday, so I will be getting it done then. It usually takes a couple of days to get the results, so in a week from today, I should have my new number to tell you guys!)

I got the Crayola!

I GOT THE CRAYOLA! MOM GOT ME THE CRAYOLA!!! (If you’re confused, please refer to my prior post about Comparing CGM’s to Crayons)

I went home Monday and had a message on my phone that Dexcom had called. I called back and couldn’t speak with the rep that hand been handling my case, so I talked with the gentleman who answered the phone. Here is how the conversation went:

Me: I was calling ( my rep ) because she just called me and I missed her call. Can you please look and see what she may have been calling about?

Rep: Yes, give me just a moment. Ah, it looks as if she was calling to let you know we have your approval and we were going ahead with the shipping details.

Me: Are you sure? It’s actually approved? You aren’t just looking at where they verified the benefits? The insurance company wrote back and approved it?

Rep: Yes, that’s what I think it’s saying, but if you would like for me to have ( my rep) return your call, I’d be glad to do so.

Me: Yes, please. I’ve already left her a voicemail, but that would be okay too.

~End of conversation

So, I waited an hour and didn’t hear anything back. I was like a little kid at Christmas. That hour may as well been a whole day… or week. Lots of clothes got folded during that time (when I’m anxious or mad, I clean). 

I later decided to call back and I finally got my rep. She was so nice. She confirmed that everything had been approved by insurance that morning and they were set to send everything out. I wasn’t expecting a decision that soon!  And neither was my rep. She said it was the fastest turn around she had seen. I was floored!  We got everything squared away and my brand new Dexcom Seven+ meter is now on it’s way. It is set to arrive Friday, but since I will not be here to receive it, I have called FedEx to hold it until Tuesday.

I have also already contacted my trainer and she will be here on the 9th if the shipment works out as planned, so, fingers crossed, I will be CGMing on Tuesday of next week!!!It's here!

**9/3/09 It is here!!! Now, to wait on training!! I will put up a new blog post when the training is completed along with pictures. Thanks you guys for all your support!!!

Comparing CGMs to Crayons…

The start of this adventure was back in December of 2008 after I started on my OmniPod system. I was getting much better control with this pump because, unlike my prior pump, this one had things like “Insulin on Board”, “Bolus Calculator”, and all that good stuff, not to mention, it was the perfect, closed loop system in my opinion because the PDM had the built in monitor as well. Everything could be kept in a neat, nice little pouch inside of my purse.

Well, as always with getting better, lower numbers, you also get more of the not so good, lower low numbers as well. I could deal with them at the time because there were only a few per week, or I’d only have one really bad day in the week where they just wouldn’t come up. But as with any time you make adjustments to lower the still-high-highs, you are more prone to getting the lows. Well, over time, I am losing the ability to tell when I am dropping low. It’s not quite as bad as some, but where I used to be able to feel a low coming on in the 80-70 range, it’s now down to the 50-40 range, and that, to me, is scary. I have a fear that I will drop too low and not be able to tell anyone what is happening or what to do. I’ve heard many of the horror stories of people passing out, and I have done so myself, and that is something I do not wish to revisit again. So, I decided to apply for a Freestyle Navigator CGM. I chose this one because it would take the same strips as my OmniPod PDM. We filed the paperwork, hassled with my unwilling doctor to get the papers signed, and waited for approval.

The weeks went by and finally I got a call from Abbott that said my insurance had denied my request due to lack of medical necessity. Okay, first off, I would like to know what doctor read my file and said that I, a diabetic of 20+ years, could not show evidence through my testing that I needed a CGM. It’s kind of like when you are a kid and you want to get crayons from the store. You want the best… you want Crayola. But your mom says, “no, these are just as good”, and gets you the dollar store waxy crayons that when you color with them, you get more wax than color on your paper. You are asking the insurance company for the Crayola… The insurance company basically says no and gives you the waxy crayon… They say “No, you can manage your glucose just as well with only doing 8-10 checks a day as opposed to having 288 readings per day, and you should have no problem attaining a great A1C to reflect it.” We were going to file for an appeal, but I never received the papers in the mail. I decided just to give it a rest and try to do my best on my own. Since then, the aim for tighter numbers has given me more lows, still in the 50-40 range, but with less symptoms than before, and also leaving me with killer headaches. Ones that have even recently caused me to lose time work because they would physically make me too sick to work. I looked over my readings on my CoPilot system, and it showed a LOT of lows in the below 50 range happening more frequently than before, most of them unnoticed…

I submitted paperwork back on the 11th of this month to Dexcom to try for their 7Plus CGM since there are reports that they are teaming up with Insulet to somehow integrate the two systems. This morning, the representative informed me that they have already verified my benefits, and were waiting on a fax from my doctors office (a new doctor, due to problems with my old doctor, we switched. That will be covered in another blog. My new one is much better and is in favor of and promotes CGMs as well), then they were submitting everything they had to my insurance company for preauthorization. So the wait begins. I am hopeful… wishful… and am being as patient as I can possibly be right now.