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?

T:slimmin’

Last night was the night. I was able to FaceTime my local trainer and be trained to use my brand-new t:slim insulin pump! I had everything together and ready to make the training as fast as possible because I also had choir practice to attend right after. I had my syringe pre-filled, new site inserted, and everything laid out where it needed to be. I thought I’d be smart and program my basal rates in too, but she had me delete everything and reprogram it just so she could see that I knew how to do it… which is totally okay with me.

Training was so simple! I was even able to hold my fussy 16-month old during the whole process (except for filling the cartridge…don’t worry, I put him down for that).

One thing that I noticed, though, is when we got to the “Fill Tubing” stage, it took a large amount of insulin compared to my Animas prime records. Usually, it only takes about 11-13 units to completely prime the tubing. Last night, it took 22.. a whole 10 units more. I was curious about this, but my trainer must have read my mind because she told me it’s due to the connection… and that makes sense. See, in other pumps that use a luer lock connection, there’s a small tip on the cartridge that goes inside of the connector of the tubing, so there’s really not much wasted space, if any. With the way the t:slim works, there is a “pocket” created because there’s a slightly bigger connection area. Not that big of a deal, but that’s what I was told was the reason for the “extra” units. Plus, I had to prime a couple of units after that to get excess bubbles out of the tubing. No big deal.

My biggest and ONLY gripe right now is that as of last night, I have no way to upload my pump… so I’m going it manually. Some have suggested a Kevin chart? I haven’t the slightest idea what that is, but I’ll be Googling it later.

Also, I hate strongly dislike the case/slider. It’s like an OtterBox for the t:slim. I mean.. I may be wrong… but the whole thing about this pump is that it’s sleek and small and stuff…. well, if you use the clip, it’s not at all sleek and small. It’s quite bulky, actually. I cannot WAIT for the t:clip to be available. I am SO going to get a PINK one and a PURPLE one!

My biggest LOVE of this pump so far? I bolus in like, a 4th of the time verses my Animas Ping. Woot! LOVE LOVE LOVE! And remember when I posted about it before that I thought the delivery time would be an issue? It’s not.  I rarely bolus over 5-6u per meal, and that’s delivered in just a couple of minutes. And truth be told, I can’t even hear it delivering.

My second biggest LOVE is the IOB showing on the FRONT screen! EEK! I thought I would miss not being able to see what basal rate I was getting on the front screen like it shows on the Ping, but honestly? I don’t. IOB is much more important and not having to scroll to status screens to see it is AWESOME. Why? Okay, so here’s a scenario: You check your BG after your meal and you see that you’re 218. Wow… that’s higher than normal for you. How long has it been since you bolused? Should you bolus again? Just tap the wake-up button and you can see that you have insulin still working and how much. If you feel that it’s not enough and you need more, all you have to do is unlock it and calculate a bolus. IF you need more, it will suggest it. If not, it will tell you that you still have X.XXu still working and if you bolus more, you could go low later. YAY! Love love love love love love love that. The ability to know right away about IOB helps me to be more aware of it and possibly not rage bolus as much.

I’m a total tech-geek. I love new technology. Granted, I am admittedly VERY excited about this pump. These are just my first impressions of it right now, so I’m sure I’ll have more to say in a week or so. I’ll keep you guys updated as I go, especially after a few cartridge changes. I’ll keep ya posted.

Abby Cadabby Returns

Abby Cadabby returns.

After a week or so on the Animas Ping and the month on the OmniPod, I have decided to go back on my Minimed pump.

Why?

The Omnipod didn’t work because I need a longer cannula length.

The Ping.. well, I used it without the remote after a few days. The remote is nice at times, but it was irritating at times too. By the end of it, I was just bleeeeh about the Ping. It’s okay, and a very stable, good pump. I honestly don’t see anything wrong with it.

So why the switch?

Connectivity.

Ease of use when it comes to technology is very important to me, and this system has the easiest (in my opinion).

It came time to upload my pump and meter and the software, for me, is a pain in the buttocks. I still like the fact that everything can be logged into the Revel so that all you have to do is upload it via the USB device and there’s your whole complete logbook.

I’m still not quite concrete about the decision yet. But I do feel better about having weeded out the OmniPod option. Now it just comes down to the Revel and Ping and whether remote bolusing means more than easier upload of data.

Seeing Double?

That’s right. There are two pumps.

My old Ping has Symlin in it, and the Revel has insulin.

I am trying an experiment to integrate using my Symlin along with my basal insulin to see if it will help closer match a regular, normal, non-bum pancreas. Afterwards, I will give full detail as to what I did and how. Am I looking for a cure in this? No, because insulin, nor Symlin, are cures. A cure will be not having to take any meds of any kind to control this mess.

It’s a work in progress, so I am not going to suggest doing this for yourself, because, as we all know, I am not a doctor – nor do I play on TV, and I didn’t stay in a Holiday Inn Express last night either. As with all cases, MY diabetes is mine, and YOUR diabetes is yours. Diabetes is different for everyone, so don’t go being a copy-cat just because you read what I’m doing here.

In a regular, functioning, loving pancreas, insulin production is matched very closely to amylin {the hormone that slows digestion (similar to gastroparesis), and the lack there of causing us to always think we’re hungry}. {It is also important to note that gastroparesis is not caused by the overproduction of amylin, rather by damage to the nerves that move the food from the stomach into the intestines.}

Last year, Symlin in the vial was discontinued, leaving us with pens. The Symlin in the pen is 40% stronger than the one that was in the vial. So, when I eat, I take my bolus of insulin, and I bolus Symlin from the Ping, less 40%:

Example:

41g carb lunch = 3.41u insulin bolus (1:12 IC ratio) = 2.05u Symlin bolus (3.41-40%)

I also have a basal rate set at 0.100u per hour, which is less than the 40% of my current basal rate, but I am not willing to match my insulin to Symlin for a basal amount just yet. {And I may not do it at all… as a matter of fact, I may even drop it down to a 0.025 minimum just to prevent clogging.} My main concern is to bring down the post-meal spikes and round them out without having the seemingly instantaneous BG drop that I had with Symlin when I used it in the past. So far, I have only dropped low once, and my spikes are nice little hills instead of multiple Mt. Everests per day. The biggest challenge so far is tube intanglement, which is starting to be a major pain in the buTtOcks.

Will update Monday as to how things went over the weekend!

Silliness

With diabetes, you gotta be silly sometimes.

Friday, being just a weird, off-day for me, (and to make a very long, extremely complicated story simple) and started off with me having to use my backup insulin pen at work. Since I don’t like the idea of wasting insulin, I figured it was time for a pump break anyways, and started on insulin pens.

Then I got this idea.

It’s Blue Friday, right? And Mike from Spain is collecting diabetes-related pictures for Diabetes 11.11.11? And my pen is blue (mostly)…

Which resulted in this:

9ggmj

Which I tweeted and facebooked.

Not too much longer, Dave (@SowerBee) tweeted me this back:

(Total AWEsomesauce, dude!)

Diabetes doesn’t always have to be so serious. You just have to know how to be fun with it.

Way to go, guys!

PS:

Happy WORLD DIABETES DAY everyone!

Have you done your Big Blue Test? If not, do it and input your results at:

www.BIGBLUETEST.org !

Revelling – Getting Started

First off, let me say that I am very sorry for not getting this post up Monday as promised. I wanted to get it done, but learning to balance a new baby and diabetes is much harder than I ever thought it would be, especially when the baby throws an all-nighter at you. The only thing we can figure is that his diaper rash is back and he was just not comfy, and that’s completely understandable. I certainly wouldn’t be happy with a messy diaper on my raw behind either. And the poor thing just makes you feel terrible when changing him, screaming his cries to the top of his little but powerful lungs and even quivering his bottom lip. I try to hold and cuddle him a little more after his diaper changes, just because you can’t help but do that. I mean, you feel bad enough changing him knowing that it’s painful, but knowing you’re the one causing him pain is just awful. It has to be done, I know, I just wish I could make it more comfortable for him.

BUT (no pun intended)! As to the purpose of this post, I am here to talk about my first few days with the Minimed Revel. The training went very well. As a matter of fact, after speaking with her for a little while, we found out that she worked at the same camp I had attended when I was a teenager! I remembered her being in the infirmary and when she called to do her follow-up check-up on me the next day, she told me she had remembered me because of my organizational skills (I’m sort of OCD about that kind of thing. I organized her pump skins by model so she could find them easier when she handed them to me to look through to find a few I wanted for my pump). I did drop low a couple of times during training, but what was so neat to me was that she could tell before I could just by the look on my face. I need to know how she did that so I can teach Erik!

The setup of the Revel was very easy. The online pre-training guides you through getting your pump ready for the training class by helping you set the time and date, and letting you become familiar with the buttons and menus. It also has a course on the basics of how shot therapy is different from pump therapy and how to adjust. As an experienced pumper (11 years now), I started to skip this training, but I went through it anyway just as a refresher, and I’m glad I did. There were a few things I didn’t know, so my suggestion is that no matter how much you think you know or how basic it may seem, give your training the benefit of the doubt and just do it. You never know what you’ll be surprised to learn.

When the trainer arrived, I had everything set out. She went through verifying the basal rates, correction factors, IC ratios and BG targets I had moved over from my Ping to the Revel. The setup was fairly quick and easy to go through. The part that got me was getting the cartridge filled and inserted. It is a lot different than the other pumps as it all screws together in a screw+lock system, unlike the luer lock systems of my other pumps. It is something you have to learn the “feel” for if you’re not used to it. The rest of the setup through the pump was very easy as the screens guide you through every step, very much so like the way the OmniPod PDM does, giving you directions with each step, whether you know what you’re doing or not. That, I liked… a lot.

Next, we got the CGM part going by plugging in my transmitter ID and starting my sensor. The coolest thing about this part was I was able to keep the Guardian connected to the transmitter as well, so for a while, I was getting readings on both my pump and the Guardian monitor. They stayed relatively close in number to each other, but just like finger sticks, they were off somewhat, with my pump reading in the lower 80’s and the Guardian reading in the upper 70’s. I kept both systems connected until the sensor time “ran out” on the Guardian, which was only a few hours later.

Over the next few days, the pump CGM stayed in line pretty well with my fingersticks, which is a good thing. And although the system my look to some as outdated and not as pretty or fancy as other systems out there, it is a very solid system. Bolusing was very easy with the bolus wizard, with only needing your input of BG (if it wasn’t automatically “beamed” over from the meter) and carb amount and it does the rest. All you have to do is review the amount and tell it to “act”. You don’t have to dial up the bolus to match what the pump suggests like you do with the Ping system. It is a simple, easy, straightforward pump, and I like that.

I’ll write another post sometime this week (hopefully) and explain a little more about my likes and dislikes of the pump.