Studying and Tuning

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.)

 

Frugality : Update

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. 🙂

Frugality

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?

Making Progress

When I went to my endo appointment in April, I was really upset with myself. Not just weight, but also just the amount of insulin I was taking and all. Granted, I was also in school and it was around the hardest part of the semester, so mindless eating was my go-to stress reliever.

Now that I’ve taken the summer off and I’m not stressing over a lot of things, not just school, I’m concentrating on my own health. Yes, I still have my normal duties to think of, but I’m working on a routine that I hope I can stick to when school starts back in the fall. When the semester ended at the beginning of May, I took advantage of the new “time off” I had and steered it toward getting active. My dear friend challenged me to a friendly walking competition of walking 50 miles by July 6th (or 5th? I can’t remember.) I have to say, I bucked it at first. There was just no way. It was getting hot here already and I don’t have a gym membership to be able to use a treadmill, so I didn’t think it was possible. But, I had 2 months to complete it, so that would mean I could just do things slow and steady – maybe 1 mile a day… not to bad, huh?

Today, a month and a few days in, I’m at 46 miles of my 50. I’ve not lost a lot of weight (about 3 pounds I think… It’s hard to know with the swelling that comes and goes). Just this past weekend? Friday night I walked 3 miles, and Saturday I walked 6 (3 in the morning and 3 in the evening). That’s 9 miles within 36 hours. I NEVER would have dreamed of being able to do that in April or even in the beginning of May (granted, I needed a lot of IcyHot that night on my calves!).

Disclaimer: AS ALWAYS, YOUR DIABETES MAY VARY!

But, where I was missing the point, was in my own diabetes care. It wasn’t until yesterday when I looked at my pump and thought, “You know, it’s been a while since I changed my cartridge.” Sure enough, I had changed it last Wednesday. That was 6 days off of one cartridge that I usually get 3-4 days out of. I checked my total daily dose averages for 7 days, and it shocked me.

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My TDD of insulin when I had gone to my endo back in April was around 45-46u per day. Yesterday? It was 29.38. That’s freakin’ awesome. Granted, I also use MyFitnessPal, and even just tracking food helped to bring it down an average of 10u from what my records show, but adding in the exercise brought it down even more.

I’m not saying that this is how it will work for you, but I have my own experience as well as I know others who have told me of how making little changes helps to reduce your insulin needs, and it’s true. Granted, I know I will never be off of insulin completely – that’s just a given with being Type 1, but doing things to help implement a healthier lifestyle through food choices and exercise goes a loooong way to feeling better, at least. If not doing it for ANY other reason, just feeling better is a huge payoff for the hard work (of course, don’t ask me how “good” I actually feel in the morning when I can’t move my legs… hoping that will pass soon!)

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This morning, I had the awesome satisfaction of filling my insulin pump with just about 100u, not my normal 150u. It felt good. I felt like for once, I had accomplished something very cool. Even though the scale isn’t moving as fast as I’d like, I’m loving the other benefits I’m seeing. I’m making progress, and that’s all that matters.

(And, I’m thinking of making this thing a monthly goal of 50 miles….Am I crazy???)

Insulin, Oh Insulin, Where For Art Thou, Insulin?

I can’t do it.

I simply just can’t do it.

I can’t bear to think that I’m throwing away as much insulin as I am with every cartridge change with Tandem’s insulin pump. It just doesn’t feel right. Not sure what I’m talking about? Let me give you a run-down.

With any competitor pump out there, you can fill the cartridge and probably waste an average of 10 to 15 units filling the tubing and site during set up. From there, you can simply run the pump down to no insulin at all if you’d like, and only be losing that 10-15 units. Over a month (if you change out every 3 days), you’re looking at a grand total of 100 to 150 units per month that you’re losing due to the space in the tubing that needs to be filled.

With *my* Tandem t:slim pump, because it’s made with a bag-design, the pump can’t read all of the units that are placed in the pump. (Emphasis on MY because apparently this is different for others. I must have gotten a dud or something) Take for instance, last night. I filled the cartridge with 160 units. The pump recognized only 115 units of that. That is a difference of 45 units that will not be usable unless after I use the cartridge, I draw it back out and re-use it in the next cartridge (which is TOTALLY not recommended). But if you were to follow everything by the letter, I am wasting a massive average if 45-55u per cartridge. That doesn’t even account for the extra 10 units that it takes to fill the tubing on top of the already standard 10-15 units. So, overall, 55-60 u per change out… every three days. That’s 550-600u per month. That’s a half of a bottle of insulin or more per month that I’m throwing in the trash can, never to be used. Just since starting back on it, in ONE week, I’m down a half-vial. I’ve NEVER used that much that fast on any other pump. I knew when I started on the t:slim that it seemed that I was using a lot more insulin, but I never sat down to actually do the math.

While I love the pump and how it works, and yes, I feel obligated to use it because it was just paid for last year, I also don’t think my insurance would appreciate the fact that I’m literally throwing out half of what they paid for. And at ~$206.99 for Novolog (I may or may not have called my local CVS to find out the cash-pay price….), I’m throwing out roughly $103.49 to $124.19 per VIAL. On the conservative side, that’s $100 per vial, and at two vials per month, that’s $200 per month… that’s a whopping $2400 per year! (verses the insulin waste of a traditional pump, that would be roughly 100-150 units per month, with more going to actually being used, that would make one vial (for me) last 24 days verses 14 days, so maybe 1.25 vials per month being used with about $26-$39 per month in insulin cost being wasted in the tubing… $312 to $468 per year. Head spinning yet? Mine is.)

Oh.

My.

Um..

No.

Ain’t no body got time MONEY for that….

I don’t know about you, but if I were flipping the bill for someone to have life-saving medication and knowing that they were throwing out half of it because of how the delivery-device worked? I’d be pretty pissed off. That’s about $2,000 more per year in insulin cost to use this pump over another one. And yes, most people have insurance to cover this, but think about it! What if you didn’t??

As much as I love Tandem and their nice, lovely, reports, and the wonderful touch-screen, quick-to-use insulin pump, I can’t fathom that a pump that is supposed to be so “green” creates so much waste in an area that is so dear to us. Batteries are much cheaper than insulin, and can be recycled. Insulin can’t.

So, it is with heavy heart that I will not be using the t:slim pump again until they resolve this. I know they want to work with me to fix the other issues I had like the random highs and things, but until they fix how it reads the amount of insulin that’s in the pump, I can’t feel right in knowing I throw out that amount of insulin just for the luxury of using this pump.

(Just so we are clear – all of this is based off of experience I have had personally with the Tandem pump. As I have learned, every pump that comes from them can work differently (my first one calculated insulin even worse than this one). What I have said here is my experience and mine alone. If you have better luck with it, good for you. My thoughts here are also based on using the pump as instructed in the user manual as well as how I was taught. Any tips/tricks/reclaiming/ or reusing is not considered in what I have calculated.)

This is me on…

Humalog Novolog

 

So, earlier this month, I was given the opportunity to trial the Asante Snap insulin pump. While, I found through the two pump bodies that I went through, that it was a very nice pump to use and very simple, the one thing about it is that, currently, it is a Humalog cartridge pump only.  I am a Novolog user, but I had been told by several different people that there really was no difference in the way the two insulins worked. While others, declared with certainty that there is, in fact, a difference.

I am one of those in the latter group. For the first couple of days, my sugars were great. I didn’t notice a difference at all, and if I did, it was actually better. Then, on day 3, it all went down hill…. or should I say.. up hill? I could not for the life of me control postprandial (after-meal) blood sugars. It would take two corrections to bring them down, and once I did, I would crash, and after I treated, I was right back up again. On days 4 and 5, the frustration was just beginning to be too much to handle. Although I had changed my site out 3 times during this short sprint, nothing I did worked. It was as if my body liked it to begin with, then just completely bugged out on me and was all like, “WTF? This isn’t my Novolog!”

So, I went back on my t:slim and filled it with Novolog. My blood sugars thanked me for it.

Since I had a couple of Humalog cartridges left over, I decided to use one with my next t:slim change-out and just pull the insulin from the pen cartridge. (You know, so they don’t go to waste and all.) Within hours, my sugars were cruising once again in the 300 range with no downward slope in sight, no matter the corrections I took.

So, here’s my hypothesis on it. Everyone, like snowflakes and fingerprints, is different. Some of us have chemical makeup in our bodies that play nice with Novolog, some that play nice with Humalog, some even go out of the box all together and prefer Apidra. And some people’s chemistry is just a party and dances with any type of insulin you give it. Mine is just partial to Novolog.

So while using the Snap pump was pretty neat and easy to use on a daily basis (hey, it really lives up to it’s name… it’s a “Snap” to use!), I simply can’t due to the Humalog-only bit. I do know they are working on getting a Novolog pen-cartridge accepting pump on to the market as well, so that will be great for all of you who are like me.