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July 31, 2008

CWD: Lancet Devices.

At the CWD conference, there was a big ol' expo going on while the focus groups were taking place.  Every company from Omnipod to Dex4 to my friends at diaTribe were interacting with the CWD Friends for Life attendees. 

Before the expo, I was talking with Sara about lancing devices.  (My life is a thrill a minute, no?)  She swears by the Muliticlix, while I had never used one before.

"You NEVER have?  We need to fix that."   

So when the expo opened that morning, we went off to find the folks at Accu-Chek, so I could try out one of their Multiclixes.  (Multiclixes?  Multiclixi?  How do you make that one plural?)  After a demonstration, some questions, and wrangling them to hand over a demo device, I also checked out the Renew booth and convinced them to hand over a sample, too.

So now that the dust has settled from CWD, I finally had a minute to try out these devices.  

First, the Renew.  I'll admit it:  It looked like a spaceship, so I was intrigued.  I liked the color choices (mine is the old lime green one they first marketed, but they have a whole new selection of colors now) and it's reasonably small.  However, I needed to read the manual before I could get the cartridge in there.  I'm not sure if it was the lack of coffee in my system or my overblown KerriBerry technojoy, but I couldn't figure out how to unhinge the thing to get the lancing cartridge in there.

Kerri and the Renew

The manual was clear, thankfully, so within a few seconds, I had the cartridge loaded up and ready to roll.  Thanks to decades of diabetes and an unquenchable desire to prick the center of my fingers instead of the sides, I have some serious calluses to work through.  I used the "3" setting at first, but that barely made a dent and produced the teeniest drop of blood ever.  Cranking it up to the "4" setting procured a good drop. 

The device is less painful (admittedly) than the One Touch lancing device I used every day, but here's the big drawback:  every new test uses a new lancet.  Yes, this is best for finger health and to avoid infection, but it's also a big, fat waste of a lancet if you aren't able to draw blood with the first prick.  Testing my blood sugar once used two lancets, and there are only 20 in the cartridge.  I'm hoping that a future generation of this product allows lancet reuse (for us old-timers who only change lancets with our clocks). And I'm also hoping that the future generation is a little smaller because while I was intrigued by the round design, it doesn't fit neatly into any of my factory meter cases.

Kerri tried out the Multiclix, too.

I also tried out the Muliticlix and Sara is right:  this thing is pretty pain-free.  The woman at the Accu-Chek booth was telling us about the patented technology they have for their devices, keeping the lancet on a track so it doesn't spiral into your finger and rip up your skin any more than necessary.  I've used it a few times already in the last day or two and the results have been pretty good.  Once I figured out how to insert the drum (I'm fumbly-clumsy these days, and it took me a few seconds to load this one, too), it was all systems go.  The shape of this device is the familiar cylindrical one, and it fits into my meter case.

Pros for this device are that you can reuse the same lancet as many times as you'd like.  Economical, in my eyes, because I'm not wasting lancets.  It also, as I said before, fits in my meter case, which makes it easier to integrate into my current routine.  The cons on the Multiclix are that the depth settings just aren't deep enough for a veteran tester like me.  On one of my least-calloused fingers, I'm using the "4" setting.  Maybe with continued use, the calluses would ease up a bit, but from my perspective now, it would be good if the settings went up another notch.  Or two.  ;)

Have you guys used any of these devices?  What was your experience - good or bad?  

(And I'm also waiting for my Pelikan Sun device to be mailed to me - more on that once it arrives!)


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July 30, 2008

KerriBerry.

(We interrupt the CWD recap to bring you yet another moment in Kerri's graceless, awkward life.) 

A few months ago, a small crack splintered across the screen of my Motorolla Q.  It wasn't too noticable, but I resolved to replace the thing once my contract ran up in August. 

Monday morning, as I was talking with my editor-in-chief, the Q slipped out of my hand and smashed against the concrete dLife floors.  (I am so clumsy.)

Holy busted Q.

"Oh darn!"  I said, substituting "darn" with another, more colorful exclamation.  The screen was destroyed.  Just running my finger along the surface sent little sprinkles of plastic everywhere.

After consulting with my boss, my co-workers, and the fine minds at Twitter, I was urged to call Verizon and see if they could bump up my renewal date.

"Hi, this is Kerri Morrone."  (The post-marriage name change hasn't happened on my bills yet.)  "I just accidentally smashed my phone against the floor and now there are pieces of the screen in my ear as I speak with you.  Can you help me?"

The customer service guy laughed.  "Oh no!  We need to fix that!"

"Would it be possible to move my renewal date to today?"  I crossed my fingers, bits of screen stuck to my left cheek.

"Ms. Morrone, I'm making that change as we speak."

Twenty minutes later, I was buying my new addiction.  This thing: 

Crackberry for sure.

I am experiencing full-on TechnoJoy.  Instead of reading the manual cover to cover, I've instead just started banging away on the buttons and checking out all the new features, making up "how" as I go along.  My boss is blue-toothing me ringtones.  My brother is hooking me up with tips.  And I actually registered at a site called (God help me) Crackberry.com.  While I love a well-tended garden, waves crashing against shore, and the overall brilliance of nature, this little techy gadget thing has me completely enthralled.

Chris made fun of me and my new gadget addiction.  He called it a KerriBerry. 

I agree:  A life would be good.

In the meantime, if you have a suggestion for a Blackberry tips site, or a useful forum I should check out for fun bits, please let me know!  I'm hopelessly addicted already.


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July 29, 2008

CWD Meets CGM.

"The problems are that they aren't accurate all the time and they don't replace fingersticks."  She adjusted her shirt collar.  "It's tough for insurance companies to get on board with that."

It's no surprise that I attended every CGM focus group offered at CWD.  From discussions about government viewpoints with Arleen Pinkus of the FDA to debates about accuracy with Dr. Bruce Buckingham, I was tuned in and looking for ammo against my insurance company's repeated denials.  (Acknowledgment of my second appeal arrived in the mail while I was away.) 

When the group (which included Manny, Sara, and the man himself - Bennet) asked about insurance coverage, the FDA lady told us that there just wasn't enough data from the Medicare crowd.  

"So you're telling us that we just need to slap a few sensors on some 65 plus diabetics and that will help turn the tide?" I asked.

She actually said, "Yes.  That would do it."

Fight for your right to monitor!

Fortunately, the CGM session with Bruce Buckingham was far more informative and armed me with enough information for my third appeal letter.  He was a warm and soft-spoken man who lead a 90 minute session about CGMs and how they can benefit the life of someone with diabetes. 

"When I worked at the diabetes camps, they called me a pancreas, because my pancreas worked," he quipped to us, talking about the history of diabetes and explaining how physicians used to taste the urine of their patients to make a diagnosis.  "The first pump was in 1978.  The first common place meter was in 1980.  I know - the pump was before the meter!"  

Dr. Buckingham talked about how CGMs don't measure blood glucose, but instead measure the interstitial fluid.  He told us that it takes about six minutes for the blood glucose to affect the interstitial fluid measurements, which helps explain how CGMs and glucose meters don't always match up with precision.  He cited that the delay is more realistically a full eight minutes.

There was a lot of discussion about accuracy.  From my almost 22 years of experience with type 1 diabetes, I'm convinced that every mg/dl result is a concrete one.  It's been a tough mental hurdle, leaping from snapshots to trending.  But Dr. Buckingham confirmed yet again that a CGM is a trending, and not a treatment, device.  Any CGM result should be confirmed on a glucose meter before treating with food or insulin. 

Another point he touched upon was that of sensor calibration.  I test upwards of 15 times per day, so I was inclined to calibrate my sensor whenever I tested my blood sugar.  "Calibrating when unsteady can cause the sensor to be biased," Dr. Buckingham said.  If I test and my numbers are rapidly rising, I'm calibrating my sensor on the climb.  That's going to throw off the accuracy for sure.  Calibrating when steady (or at least steady-ish ... diabetes is never completely precise) helps retain the integrity of the sensor.  But there is always a lag time with subcutaneous sensors, i.e. recovery from a low blood sugar may not be apparent on a sensor in a timely fashion.

All these technical details were well and good, but I wanted information on what made someone a good candidate for a CGM (particularly in the eyes of insurance companies).  Dr. Buckingham provided a list of possible candidates:

  • patients at a high A1c
  • patients with a fear of hypoglycemia
  • hypoglycemic unawareness
  • pregnancy/preconception
  • gastroparesis
  • athletes
  • patients on medications like pramlintide (Symlin) and exenatide
  • patients who may wear the sensor intermittently to better understand their own diabetes

I saw myself on that list several times.  Dr. Buckingham told the group about how a CGM can provide fantastic feedback that can really affect diabetes management decisions.  He said that the immediacy of the feedback helps identify causality, meaning that we could see how different foods affect blood glucose levels, and that the data can be use to prevent or detect earlier extremes in glucose levels. 

He did have some warnings, though.  He warned about over-calibrating (as discussed before).  He also warned against insulin stacking (taking small bolus after small bolus in efforts to correct highs). He also acknowledged that some of the alarms weren't effective, and that many PWDs slept through them.  One tip he offered was to keep the CGM receiver in a glass on the bedside table, so that when it vibrates, the rattle in the glass helps wake you up.

"It doesn't work unless you wear it," he offered, adding that the sensor is a behavior modification tool and if you aren't ready to accept diabetes, you may not be ready to wear an extra device.  According to Dr. Buckingham, a CGM can make someone feel vulnerable and defensive, with every number out there on display.   

But then he said this:  "A CGM can help you achieve a better A1C without increasing hypoglycemia."  I thought about the lack of lows I've had in the past few months, and I was happy to not be crashing and burning in the middle of the night.  But an elevated A1C also came along without those lows to tip the curve.  I'm so hopeful that a CGM will help me gain better control of my diabetes without tossing my numbers down the well every few days.  

I thought about how Chris said he feels safer when I wear it.  My mom said the same thing.  And I agree.

Come on, Insurance Companies.  Get on board!!

Editor's Note:  Do you want to join the fight for CGM coverage?  Sign the CGM Denial Petition and Raise Your Voice!! Also, Dr. Bruce Buckingham is leading a chat about Continuous Glucose Monitors on DiabetesTalkFest tonight.  Log in at 9 pm EST!

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July 28, 2008

CWD: My First Time.

My diabetes greeting card.Up until last week, I had never been to a CWD event before.  I had heard about them through the diabetes community, and I knew that many of the parents who were reading my blog were members of the CWD forums.

Now I know why people are so into CWD.  It's like coming home.

These people get it.  I've said that before about my best friends, who do their best to understand the subtleties of diabetes, and about my wonderful co-workers, who go to great lengths to know what a real "dLife" might be like. But the parents and children at the CWD conference are the ones on the front line, the folks who are living with this disease every single day, either as the diabetic themself or the caregiver of a PWD.

The CWD Friends for Life conference in Orlando is filled with parents who care.  With kids who boop beep boop and shunk and who know the carb content in their favorite breakfast cereal.  With grandparents who can proudly program a pump, or siblings who know how to treat their brother or sister's low blood sugar.

It's also filled with some of the diabetes medical community's finest, with Fran Kaufman, Bruce  Buckingham, Richard Rubin, and Barbara Anderson among the faculty.  I attended several focus groups about diabetes and pre-pregnancy planning, CGM use, and the artificial pancreas.  (The groups deserve their own posts, so more on those later in the week.)  I also had a chance to meet with some of d-blogging's most friendly faces, like Manny from TuDiabetes and Sara from Moments of Wonderful

The first focus group I attended was about Diabetes and the Web, which has people talking about websites they frequent for their diabetes care.  A little girl sitting in front of me, about 8 years old and with an insulin pump clipped to her shorts, said "I visit dLife to find recipes I can eat."  My heart swelled with pride. 

They asked us to envision cards we'd receive from our endocrinologists or CDEs.  "What kind of card would you want to receive from your doctor?"  Even though the group was dominated by children, there were several adults (myself and Manny included) who grabbed for the crayons with vigor.  

The front of my card read:  "Do you have diabetes?"

Inside:  "You are still YOU."

After sharing our cards with the group, the leader asked when we'd want to receive these cards.  On our diagnosis anniversary?  After we have an A1c done?  When we're feeling frustrated?

"I'd take these cards anytime.  Randomly, monthly ... daily."  I said. 

A father in the group laughed.  "Me, too." 

I've said it before and I'm sticking with it:  Diabetes doesn't define me, but it helps explain me.  And attending this conference drove that point home.  I was one of many, united by a common medical bond, but I was still me.  A pump in my pocket, a meter in my bag, and two decades of diabetes under my belt - but I was still me.  And I wasn't alone.

Thanks for the warm welcome, CWD. 

(I have a Flickr set of the conference online now - feel free to poke through if you have time.  More on the conference to come!)

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July 23, 2008

CWD: Pictures Say 3,000 Words, Then I Say A Few.

It's late, but I had to load up some of the pictures from today.

Kerri Sparling and Jeff Hitchcock

This is Jeff Hitchcock, the mind behind the CWD website and the founder of the conference.  This photo was from the First-Timers seminar, which helped people like me who had never attended the conference before to get a sense of what it's all about.  (And what's it all about?  I'll get to that in a minute.)

Kerri Sparling and Doug Burns at CWD

Doug Burns was also popping about, and he took a few minutes to help me muddle through some of my fitness questions.  There's something so empowering about seeing someone in terrific physical condition and knowing they've reached that level despite the chaos of diabetes.

Le Bloggers

And this, well, this is what it's all about.  A few bloggers met up for dinner tonight and "talked shop."  (A few people are missing from the photo - it was a revolving door at our table!)  It's an honor to share stories, advice, and laughs with people who really understand.  Thank you so much to everyone I had the opportunity to meet today.  You guys are seriously bad ass. 

(No, I didn't have a chance to unmask Goofy today.  But there's always tomorrow.  Watch out, Goofy.  I'm lookin' for you.)

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July 22, 2008

Landed.

Landed!It's been a long day of crappy airplane food and kids behind me on the plane repeatedly kicking my seat and hollering "Mickey MOUSE!!  Mickey MOUSE!!", but I've landed in OrLANDo (cannot resist a crappy pun, sorry) and have checked in to the hotel for my first Children With Diabetes "Friends For Life" conference. 

I'll take copious notes on the chaos that is sure to ensure, and I'll have my trusty camera at my side every day, so hopefully I can get some good shots of the event.  Or maybe I'll be able to duck into the secret tunnels underneath Disney World and see what Goofy looks like without his head on.

To unmask Goofy.  That is my CWD conference goal.  Oh, and to learn stuff.

More later!

July 21, 2008

Blue Bird of Happiness.

We drive.  Friday night, after taking in the new Batman movie, we hopped in the car late at night and drove home to RI.  (Late-night driving means less sleep but also means less traffic, and we'll take the latter, thanks.)  Saturday morning had me at the beach with a few of my college roommates, then dinner out with family on Saturday night, then breakfast with Batman (my friend, not Christian Bale), then a cookout at my mother's house on Sunday afternoon.

It sounds like a lot of driving because it IS a lot.  Chris and I try to connect with as many of our friends and family as possible when we come home on the weekends because we don't have the opportunity to see them for several weeks on end.  Connecticut, though filled with career opportunities for us both, doesn't have much in the way of family.  And lately, family and friends are something I've been missing tremendously.

I've hit a very rough patch, diabetes-management wise.  My A1c came back the highest it's been in five and a half years, and I didn't take the increase with any grace at all.  Even though I can attribute the rise to wedding chaos and honeymoon laziness, I still felt so disappointed.  In addition to an elevated A1c, I've also been diagnosed with a disorder called Factor V Leiden, which can cause blood clots and has forced me to change some of my routine (read: birth control pills are now a no-no).  Despite the fact that this disorder is unlikely to cause problems, it's still a new blip on my health radar and contributed to my feeling of "eh" last week.  I was feeling overwhelmed with health concerns, frustrated with insurance issues for the Dexcom, and pretty damn grumpy.  Crumbs Morrone ... er, Sparling.  Crumbs Sparling.

I needed some time with friends and family this weekend, to help take the edge off a roughish week.  And it worked.  Yesterday afternoon, I was hanging out in my mother's yard, taking pictures of her garden.  My mom is very whimsical and a little silly, and her yard is crammed with flowers and these strange little garden critters that she finds from the Christmas Tree Shop:  small ceramic ducks, little turtles, and garden gnomes.  It sounds like her lawn is littered with trash, but these creatures aren't just flung about haphazardly.  They're carefully placed, hidden between hydrangea bushes and underneath rhododendrons.  You have to look for them to find them.

Bluebird of Good Health 

I came across a big, fat, ceramic bluebird yesterday.  It was in her front lawn and guarding an azalea bush.  

"Bluebird of happiness!"  My mother came by, checking out what I was photographing.

"I see that."

"Well?  Doesn't it make you happy?"

I thought for a minute.  I felt revitalized after being socially reconnected with my friend and family.  I felt ready to make the medical changes necessary to accommodate the new condition and to take change of my diabetes management once more.  I felt loved.  Supported.  Happy.

"It does, Mom.  That fat bird totally makes me happy."  She grinned at me. 

Onward, right?  All I can do is get over the bad news and move forward towards something better.  Good health is one day at a time.

July 18, 2008

Diabetes For The Day: Part Two.

A few weeks ago, I had a co-worker who wanted to experience diabetes for the day to help him better understand what life with diabetes can be like.  His experiment prompted another co-worker to want to give it a go.  For her day, she tested her blood sugar approximately 10 times, wore a make-shift "insulin pump" that we fashioned in a hurry out of a Kool-Aid box (sugar-free Kool-aid, don't worry), and tried to "think like a diabetic" as best she could.  She recorded her numbers, her food, and her experiences.  (And her feedback was amazing - check it out!)

Makeshift insulin pump
Insulin pump made from yarn, a band-aid, and a Kool-Aid box.  Of course!

Kerri:  You have a very definitive food philosophy.  Why do you eat the way you do?

Co-Worker:  I’ve been writing about health and nutrition for 10 years now, and as I’ve followed the scientific literature, I’ve formed some basic beliefs about the way we fuel our bodies and how that impacts everything about us. I tell people to think “caveman” any time they are unsure about how to eat (or even exercise). Our DNA hasn’t changed a bit, and our bodies were beautifully designed to thrive on the nutrients that come from animals, fish, and plants. Diabetes or no, when we eat “from the earth,” blood sugar and insulin levels are steadier. When we consume too much of the stuff that is made in factories and comes with a long list of ingredients on the box, among many other negative effects blood sugar and insulin are on a lifelong rollercoaster. And, increasingly, research is showing this is an important factor in the physiological damage that leads to cardiovascular disease and even cancer.

(Are you bored yet? Can you believe I still find it all fascinating?)

Kerri:  How did testing your blood sugar affect the way you thought about food?

Co-Worker:  It didn’t change what I ate or how I thought about my food, but it made me more conscious of my various states -- very hungry, very full, lightheaded. Because I was obsessively looking at the clock all the time and figuring out when I could test next and wondering what my blood sugar was doing.

Kerri:  Did you find the blood sugar testing to be painful?  How comfortable were you with the process?

Co-Worker:  The actual prick didn’t bother me, except when I accidentally had the thingie turned up to 4. But I ended up with a surprisingly sore fingertip the first day, because I thought I should do all of my pricks on the same finger for some reason. When I got in my car, it hurt pressing the button to make my window go down and when I was doing yoga later, it hurt to have my fingertips pressing into my mat!

Close-Up of Pump
This was how we clipped the "pump" to her clothes for the day.

Kerri:  How did the blood glucose numbers make you feel? Did any of your results make you raise an eyebrow?

Co-Worker:  I expected to see more fluctuation, so the steadiness of my numbers amazed me. And I have to say, I felt great about my numbers because they seemed to vindicate -- in a very concrete way -- the way I eat and the way I advise others to, which is basically protein with everything you eat, no low-fat anything, and treat all “white” foods as if they’re straight sugar. And don’t drink soft drinks other than unsweetened tea. My consistent blood sugar levels made me feel more confident that I’m doing the right thing and interpreting the research correctly. My poor friends and co-workers! If I wasn’t already, I will now be totally insufferable.

Kerri:  Do you feel as though you have a better idea of what life with diabetes is like?  What else would you want to know?  What are you grateful for not knowing?

Co-Worker:  Just a tiny bit, I guess. It was humbling to see that I can prick my finger a gazillion times and end up with blood spots on my clothes and experience the exasperation of running out of test strips and yet, really have only a smidge of an understanding of what it’s like to be in the shoes of someone living with real diabetes. I did have this one moment where I realized I’d forgotten to test and I was exercising and I kind of panicked for a split second, as if there could be real consequences. And there was another time when I was sitting somewhere very relaxed and having fun and suddenly had another little momentary freak-out that I’d forgotten about the whole diabetes thing for a little while and oh my god, did I mess up my experiment? I guess what I’d like to know is how well someone with real diabetes would do eating the way I do, and how closely you could stick to it. And what I’m grateful for not knowing is what’s it’s really like having to stay so on top of something 24/7. There’s nothing in my life I need to be aware of all the time like that. And the only time I did feel that was when I had a baby and that’s just a bit different.

Kerri:  Did this experiment make you appreciate your health any more?  Less?

Co-Worker:  I’m pretty good at appreciating my health, because I’m a cancer survivor and maybe a bit because of what I do. But did it make me aware that I’m lucky I don’t have diabetes? Yes. Unless having diabetes would mean I’d be more like Zippy, my hero.

[Editor's Note: This particular co-worker has slapped the nickname of "Zippy" on me because I'm incessantly chatty and fast-talking.  Hers is "Princess," for dozens of lovable reasons.  We all have nicknames here in the editorial department - and t-shirts to prove it - but that's a story for another post. :) ]

Zippy - er, Kerri:  Do you think other people who are close to diabetes, but aren’t diabetic themselves, should spend a day as a diabetic?

Co-Worker:  I think everyone should. Honestly, for some, it wouldn’t really increase their level of empathy or understanding. But yeah, if we’re talking about borderline type 2 -- and it’s a result of poor eating and lifestyle -- if I were a doctor and I wanted to strike fear in my patients’ hearts to get them to start taking care of themselves, I might use it as a strategy.

Kerri:  Anything else you want to add?

Co-Worker:  Oh my gosh, no. I’m such a blabbermouth. :)

The results of her blood work were as follows (these are her notes):

WEDNESDAY
7:08am  102
Coffee with half and half and splenda

9:22am  121
More coffee, 1 plain cookie, nuts

11:37am  130
1:20pm  95

Snack & lunch: HB egg, cheese stick, nuts; small pesto pasta w/chicken,
small beet salad, 3 plain cookies

3:45  131
6:20  107

Yoga class, drank coconut water

7:50  126

Thin crust pizza with mushrooms, spinach, garlic oil; salad, olives, 2
glasses wine

9:19  105
10:54  95

THURSDAY (did not write down food)
7:30am 101
11:39am 99
1:52pm 98
Lunch
3:20pm 102

I think her numbers are an interesting contrast to those of my other co-worker, who ate more pizza and white breads and subsequently saw more spikes.  It's amazing to see how food affects people without diabetes  - this helps me to clearly see how food affects me. 

Another co-worker just finished her day with diabetes, and I'll have her results in the next few days.  Have a great weekend, guys, and I'll see you on Monday!! 

July 17, 2008

Give Me The Sample!

Antisocial little droplet
Hiding in my fingertip.
I called for you - you did not answer!
Forcing me to now reprick.

I lanced again, into the tissue,
Calloused hard from all these thuds,
I squeezed my finger with the purpose
Of procuring bright red blood.

But no!  My body stayed so stubborn,
Not giving me a proper sample.
"I'll change the lancet - then I'll finally
Get results."  My smile was ample.

Knowing that it wasn't time
To change the clocks or check detectors,
I still swapped out my old lancet
For a fresh, sharp blood collector.

I pressed the button, heard the shunk
And felt the sting of proper lancing,
Squeezed my finger, saw the blood
And did a jig of happy dancing.

I'd forgotten how convenient
It could be to just prick once -
Leaving me, the lancet horder,
Feeling like a mild dunce.

I suggest, my Faithful Readers
That you heed my sage advice.
Don't forget to change the lancet -
Prick your finger once, not twice!

Three little blood droplets, all in a row...

July 16, 2008

Body Image.

What fits.Beauty benchmarks seem to be measured in what size pants you fit into and what designer hand bag you have draped over your rail-thin arm. 

This is the biggest bunch of crap I have ever heard.  In my life.

There's a lot of body image problems in our society.  Women are shown almost-unattainable media images and are encouraged - expected? - to achieve that look.  As a girl with diabetes and part of a family of curvier people, whittling my body down to that socially mandated size isn't easy ... and wasn't accomplished.  Life with diabetes puts a huge emphasis on food, making me unable to eat just a raisin for lunch.  Instead, I ate in accordance with the then-peaking of my insulin and tried to keep my weight, and my diabetes, under control.  This was difficult at times.

I was never a "thin" adult.  I've always had more of an athletic build than that of a runway model.  As a kid, I was scrawny, but once puberty hit, my body took on womanly curves and held fast to them.  I never felt shapely or feminine - instead, I felt fat. In college, I lived with six other girls (six until me?) and they were all teeny little things.  They had thin arms and thin legs and they shared clothes with one another, but I couldn't get in on that scene because I was about two sizes bigger than all of them.  If they were wearing size 4 pants, I was in an 8.  I always felt a bit bigger, a bit more awkward, and very shy about my body. Despite whether or not I looked as overweight as I felt, my mind was entrenched in thoughts that were self-conscious.  I was very unfair to myself, just like many other women are.  It sucks to feel bad about yourself.

Diabetes challenges my health, but it sometimes offers up a healthy perspective.  It took me several years to really come to terms with the fact that my body needs to have different priorities.  Going to the gym has become less about slimming down my stomach and more about improving my cardiovascular health, lowering my A1C, and reducing body fat so that I can make better use of my injected insulin.  It couldn't be about fitting into a smaller dress size because it needed to be about being healthier every day.

I'm not going to be teeny.  I will not be the girl who appears to be challenged by every breeze that blows through.  My body will be strong and curvy and ornamented by various medical devices, like a diabetic Christmas tree.  It's taken me a long time to achieve a level of confidence in how I look and how I feel about myself.  But I see myself now and realize that I don't look much different than I did in high school or in college.   I just feel different.  I feel like the numbers that matter aren't the ones on the scale or sewn into the tag on my skirt, but instead the ones stored in my meter. 

I feel happy, and that looks better on me than any stitch of clothing I own.

July 15, 2008

Bolus-Worthy?

Last night, I was in the city with my co-workers for Ricky Gervais (guy from the original Office) and we left straight from work.  Gervais, though he played for only about an hour, was terribly crass and clever and peppered his jokes with British witticisms and some aptly placed f-words ... which means I laughed my ass off at every inappropriate bit.  (Granted, he's not as funny as Eddie Izzard, but there aren't many who are.)

Ricky Gervais in NYC

Before the show, the group of us stopped at a restaurant near the WaMu Center and grabbed a bite to eat.  I decided to go "off the carb wagon" and order up a cheeseburger.  Then my co-worker got a slice of red velvet cake which made me crave my wedding cake.  So I snaked a few forkfuls of that, too.

Needless to say, this meal took about seven units to cover it.

For me, there are plenty of foods that are worth garnering the "Whoa, you're eating that?" response.  Red velvet cake with cream cheese frosting would be one of them.  Cheesecake from the Cheesecake Factory in Providence is another.  Oh, and fresh baked Italian bread dipped in extra-virgin olive oil with sea salt and garlic chips.  That may be the most bolus-worthy carb influx of all time.  And a few years ago, a chai tea latte was totally worth the insulin (but now I can't justify drinking calories - I'd rather actually eat them).  My bolus-worthy choices change with the tides, but there's always those few items that I'm willing to crank up my pump for.  Black raspberry ice cream from St. Claire's Annex.  A bowl of linguine with alfredo sauce.  Strawberry shortcake in the summer.  Yum, yum, yum.

Food is one of those things that walks a fine line in my life.  I'm usually very consistent with my dietary choices, sticking closer to green beans and chicken than pasta and meatballs.  But I'm not one to assign "good" and "bad" attributes to different foods.  That's always struck me as a tricky attitude.  An ice cream cone isn't "bad" - it's just meant for a certain time, place, insulin dose, and blood sugar level.  Denying myself some culinary treats doesn't help me maintain a healthy food-i-tude, but instead can make me want to go hide behind the dresser and eat a pint of ice cream in secret.  (And believe me, I binge-ate in secret as a teenager due to complicated emotions about food and diabetes.  Was not fun.)  I want to enjoy what I'm eating.  Having access to technology like an insulin pump, fast-acting insulin, and a CGM opens up eating options that weren't easily made part of the equation when I was diagnosed over 20 years ago.  While a lower-carbohydrate diet keeps my numbers steadiest, I can indulge in the occasional delicious treat without sacrificing blood sugar control.

Holy crap, that last sentence sounded like an advertisement.  How 'bout this:  Cake or death?  Um, cake please.  Side of insulin, thanks.

What are your bolus-worthy foods?  (And here's a short Ricky Gervais clip about Humpty Dumpty, which made me laugh so hard I cried.)

July 14, 2008

Donald Trump Sausage.

(This is another bit of a grost (gross post), but it made me laugh too hard not to share.)

I had to groom Abby the Fat Cat on Saturday morning.  The aftermath included a happy Abby and a disgusting ball of AbbyFur. 

Somehow, the furball ended up on Siah's head. She sat there, patiently, balancing it like a seal.  And she looked so much like Donald Trump that it made me laugh.  Hard. 

Donald Trump Siah Sausage 

There is no reason for this cat.  No reason at all. 

Also, there was no reason for my entire morning today.  I woke up feeling fine (a bit tired, but overall fine) and headed into work.  Around 9 am, my head felt like it was splitting open on the left hand side and my eyes couldn't even look at the bright computer screen.  My co-worker, who has experienced migraines before, confirmed for me that I was enjoying my first migraine headache.

"You mean it's normal for me to feel like my eyes were dilated and now I can't see right?"  I asked.

"Not abnormal."

"This is crap."

After an hour of attempting to write and focus on work, I couldn't take it anymore.  I had to drop off the radar for a few hours to reclaim my brain.  After a nap in a cold, dark room in my apartment, I felt much better and returned to work.

Do you guys get migraine headaches?  This is the first one I've ever had and it was wicked.  I do not ever want to experience that again, and I have such respect for people who have these headaches regularly.  Is this a common occurance for people with diabetes?  How do you manage your migraines?  And what the heck can I do to keep this issue from cropping up again?  Any help you can offer would be much appreciated.

Headaches suck. 

(And, in case you haven't noticed the changes, I've done a bit of a reshuffling of the content here on my blog.  There's a new archives page and a three-column layout now, in addition to a bunch of other crap that I'm still muddling through.  Let me know what you think!)   

July 11, 2008

A1C You Soon.

Image courtesy of the BloodBankOnWebThe paperwork has been on my desk, but I kept staring at it for a long time.  And by "long time," I mean three full months.  I kept finding reasons to put it off - my wedding was coming, I was busy at work, my shirt sleeves were too long - but the real reason was because I knew the number would be kind of crap.  A1Cs are never fun, and they serve as a sort of diabetes report card.  With my stress levels being a little out of control during the wedding ramp-up, my numbers followed suit.  And I didn't want to know what my A1C was, out of fear and stubbornness. 

But on Tuesday, I turned my brain off for a bit.  I grabbed the paperwork, left my office, and drove directly to the blood work lab.  I refused to psyche myself out (and I tried really hard not to think about the pinchy needle easing into that tender part of my arm ... not a fan). 

"Hi, I'm Kerri.  I need to have an A1C drawn."

"Okay, write your name on the sheet here and have a seat."  

I wrote my name, thus making it official.  I was there, for my A1C, and there was no turning back.

I'm not sure why I shy away from this test so much.  I think it's because I have spent over twenty years putting so much of my self-worth into this percentage.  When it comes back under 7%, I feel like these moments of diabetes difficulty are worth the effort.  I feel strong and confident, like I'm really making strides in achieving good health.

But the bummer numbers.  The ones that are over 7% and cause the endocrinologist to check the "uncontrolled type 1 diabetes" box.  My Internal Motivational Speaker screams in protest at this box checking.  "Hey!  Uncontrolled?  Dude, she's paying attention and really putting forth a huge effort to manage this disease!"  I get overwhelmed by the possibility of complications and maybe not having a healthy pregnancy.  The parts of this disease that I try not to think about, try not to focus on, creep into my thoughts and whisper in my ear.

The phlebotomist put the rubber thing around my bicep, asking me to make a fist.  "To bring out your vein," she said, preparing the needle.

"Oooh, I'm not a fan of needles," I admitted.  

"But you take needles all the time, right?  With the diabetes?"  She tapped my arm a few times with her finger.

"Sort of.  I have a pump.  And a CGM," I gestured to the Dexcom sensor on the back of my arm.  "This takes blood sugar results for me so I don't have to prick my finger so much."

"Aye!  The finger prick!  I do not like that so much at all.  I am a diabetic type 2.  The finger pricking makes me all ... " she made a face to let me know how much the finger pricks stung.  "I do not enjoy it."

"Well I don't enjoy having blood taken.  That's why I am nervous."

She laughed at me softly.  "And that's why you are staring at the wall instead of looking at your arm, right?"

"Damn straight."   

Now I wait.  I should have my results in a few days, and I'm really hoping that this A1C result doesn't reflect the weeks of stress and honeymoon and worky bits.  I hope it shows the hours at the gym, the healthy eating, and the constant monitoring.  Either way, knowing this number is important.  Some would say it's half the battle.  But I wouldn't end this post with a silly reference to GI Joe ... would I?

Fur Coats.

IdiotsI was on the highway coming to work this morning, looked over to my left, and saw a man.  In his black BMW.  Wearing a full fur coat.  In July. 

Can't say anything else about this - it was too startling all on its own.

July 10, 2008

Slackin' A Bit.

Larry Bird is my workout buddy.  In my mind, at least.The phone rings.  I look at the caller ID and groan.  I do not even want to pick this call up because it's going to be nothing but a bunch of nagging and I don't want to ...

Kerri:  Hello?

Silence.

Kerri:  (sighs)  I know it's you.  

Larry Bird:  (laughs)  Dude, you always know.  How do you know?  It's like you have a sixth sense or something.

Kerri:  Or caller ID.  You're calling my cell phone.

Larry Bird:  Oh.  

Kerri:
  Besides, I sort of figured I'd hear from you this week.  But I have a good reason!

Larry Bird: 
Kerri, I can't think of a single good reason you haven't been to the gym since Monday night.

Kerri:  Larry, Chris was sick with a nasty cold.  And I wanted to stay home and keep him company ... you know, hang out a little bit?

Larry Bird: 
Great, so instead of going to the gym and doing me on the treadmill, you decided to stay home with your husband's germs and see if you can get sick, too?  (giggles)

Kerri:
  I wanted to hang out with him!  I don't need to justify that to you ... dude, why  are you giggling?

Larry Bird:  I said (giggles uncontrollably) "do me on the treadmill."  Out of context, that just sounds ridiculous.

Kerri: 
(laughs)  You have a point.  And I'm going to the gym tonight, so get off my case, okay?

Larry Bird: 
You know I only bug you because I care.  Otherwise I'd just call you, say "Merry f#%&ing Christmas," and bury another three-pointer.

Kerri: 
Another good point.  Okay, thanks for checking in on me once again.  I promise to be more on the ball with getting some exercise in.  But I swear, I've been to the gym five times a week for a good long time now.  It's officially a routine.   I won't let it slide.

Larry Bird:  Good to hear.  Best to the husband.  Be good to him, okay?  There can only be one.

Kerri:  Merry f#%&ing Christmas.   (laughs)

Larry Bird: 
Smartass.  

Click.

July 09, 2008

CGM: Denied Once Again.

Please approve my CGM!Dear Insurance Company,

I got your letter yesterday.  I opened it up and saw your second denial.

"Our Medical Director has decided to uphold the initial adverse determination because this monitoring system has not been proven to be any more effective in the management of diabetes mellitus than the standard monitoring."

I disagree.

I test my blood sugar 15 times per day.  I test when I wake up, before I eat, after I eat, before I exercise, while I exercise, before I sleep, and sometimes in the middle of the night.  I also test when I feel "off."  I try to catch the fluctuations as often as I can and I respond accordingly.  Unfortunately, I am only seeing snapshots with this "standard monitoring," instead of the streaming video I get from a CGM.  Maintaining tight control is difficult with only snapshots of information.

I got married two months ago and my husband and I are planning to start a family in the next year or so.  As a type 1 diabetic for over 21 years, preparing my body for baby is a bit of a daunting task.  My endocrinologist has told me to bring my A1C as close to 6% as possible.  I am starting the Pregnancy Clinic at Joslin at the end of the summer and am working hard to run my numbers tight.  Unfortunately, running at a tighter clip results in more low blood sugars. 

Sometimes I don't feel my low blood sugars.  I've felt perfectly fine and then tested to see a result of 38 mg/dl or 41 mg/dl or 45 mg/dl.  These are not safe numbers.  As a result of my efforts to lower my A1C, it takes longer for me to feel the lows.  I have hypoglycemic unawareness.  A CGM would keep me safer from these undetected lows.  And when I'm pregnant, it would protect me and my baby - at no extra cost to your company. 

And in January 2003, my then-boyfriend woke up to find me unresponsive and sweaty.  He tried to get me to drink juice but I fought him off.  The paramedics were called and it took three of them to hold me down and administer glucose.  After a tube of glucose gel, my blood sugar was 44 mg/dl.  Had my ex not woken up, discovered I was low, and called the paramedics, I may have died.  Let's just think about that for a minute, okay?  Dead, thanks to a low blood sugar that I did not wake up for.  A CGM would have warned me about my falling glucose with a loud and relentless BEEEEEEEP.  I would have woken up, tested, and most likely caught this low at 60 mg/dl instead of whatever low I achieved that morning.

While I believe that your company should respond to these issues on an empathetic and proactive level, you may only care about the financial aspects of this issue.  I offer the following:

The Dexcom unit I am using was given to me by the company.  You would not need to purchase the receiver unit or the transmitter at this time.  This is a savings of $1000.00.  What I am looking to cover is the cost of Dexcom sensors, which are $240 for four sensors.  Over the course of a year, these sensors would cost $2,880.

To offset this cost, I would be testing less frequently.  I would go from testing 15 times a day to approximately 7 times, saving $5.00 a day.  Over the course of a year, I would be using 2,920 less test strips.  With test strips costing approximately $1.00 apiece, this would be a savings of $2,920 per year. ... Wait a minute, that's saving more than the sensors are costing.  Looks like you guys just made $40, not to mention co-pays for these items! 

We should also factor in the cost of an ambulance ride, if I were to have another low that required assistance.  Medical intervention could cost upwards of $1,000.  The CGM is a measure that could prevent this cost from occurring.   

These are just the immediate cost savings to your company.  Never mind the savings that will accrue long-term, when my body remains healthy as a result of achieving a tight A1C instead of developing expensive diabetes-related complications.

Overall, it makes more financial sense to invest in a CGM for me.  Proactive measures will keep me from costing insurance companies large sums in the future, when more serious issues may arise as a result of several decades of diabetes.  

And, as an added bonus, I will be healthier.  Imagine that.

I am looking forward to your response.  

Sincerely,
Kerri Morrone Sparling 

July 08, 2008

Technology Is Fun!

No energy for a real post.  Here's the rundown:

  1. I have spent the last few weeks preparing to move my site from Yahoo! (crap) to LiquidWeb (good so far).  This has been a tedious experience, but the folks at Liquidweb have been accessible, patient, and fast.
  2. Yahoo! has worked hard to muck up the process at every turn.
  3. Developed intense hatred for Yahoo!.
  4. LiquidWeb repointed my DNS in the wee hours of last night instead of the wee hours of tonight (oh shit), having me wake up to a stunted site and nothing newer on SUM than a stale ol' post from July 2nd.
  5. I got coffee.  Nothing can be healed without coffee.
  6. Exchanged flurry of panicked emails with LiquidWeb dudes.  Asked many questions, including several variations on "What does that mean?"  "How do I do that?"  And "Where the hell do I find that?"
  7. Received second CGMS denial letter in the mail.  Furrowed eyebrows, then filed away to deal with tomorrow.
  8. Drank more coffee.  Focused on work.  Tuned back in to the web crisis when the LiquidWeb guys rang me at work and started pouring their techy genius into my head over the phone.  Felt overwhelmed.  
  9. Likened myself to a "cavewoman banging her fists against the keyboard in frustration" in an email to tech support.
  10. Laughed when tech support signed their email back "Unga, Caveman."
  11. Discovered that my SUM email wasn't working. 
  12. Panicked and told co-worker that my brain melted due to site melting.  She retorted that her boyfriend rides a boogie board.  Her story made me laugh so hard I forgot about my email troubles.
  13. Turned focus back to work.
  14. Went home after receiving a promotion at work (yay!).  Also received phone call from TechGuy at Liquid Web, telling me that the site has been restored (also yay!).
  15. Danced small jig of glee.  Almost twisted ankle.
  16. Attempted to figure out new email system and the perils of a new FTP.
  17. Posted this blog.

I'm hoping that the site hiccups are minimal as I settle in to this new server.  Once the hiccups stop, I'll be rolling out a redesign - once I finish it.  :)  And at the moment, my email is being a bit wonky, so if you emailed me and I haven't responded, please resend. 

In the meantime - Siah!  Don't cut the red wire or the whole site will ...

Don't cut the red wire!

Site Maintenance.

Six Until Me is under construction for the next few days.  Updates will be spotty and you may see some bizarre blips for a bit.  I have a great team working on the issues, so stick with me and check in later this week to see the redesign!

-- Kerri. 

July 07, 2008

Toofus.

Image credit:  http://homepages.cae.wisc.edu/I know this is how it will go when I get to the dentist's office:

Dental Hygenist:  Okay, Kerri.   You just need to sit right back here and relax.

Kerri's Mind:  No relaxing.  No relaxing at all.  Get that freaking bib away from me. I do not want to sit in this damn chair.

Kerri:  Sure thing.

Dental Hygenist:  Great!  So let's just get started with your cleaning, okay?  First, I'll stuff your face with cotton balls and then scrape at your mouth with this metal hook.

Kerri's Mind:  Get the hell away from me.

Kerri:  Sure.  

Dental Hygenist:  You haven't been to the dentist in about a year.  Why such a long gap between cleanings?

Kerri's Mind:  You people terrify me.  It hurts when you scrape around in my mouth and the anxiety just about kills me.  I hate coming to the dentist.  I'd rather take a plane ride.

Kerri:  Oh you know - I've been really busy with work and traveling home and all that stuff.  (Nervous laugh.)

Dental Hygenist:  Okay, well it looks like you have some build-up.  Let me just balance my elbows on your jaw while I dig around in here.  Then the dentist will come in and make you cry.

Kerri's Mind:  This is f-ing torture.

Kerri:  No problem.  Thanks.

I am long overdue for a teeth cleaning and a dental check-up.  I've been reading through the diabetes and oral care articles at work and they've made me realize that I need to get my arse to the dentist.  While I brush my teeth several times a day with my Oral B Super Jazzy Toothbrush, floss daily, and use mouthwash to prevent gingivitis, these at-home dental moments aren't a substitute for a real teeth cleaning.  I just have the world's most sensitive teeth and every moment at the dentist's office is completely uncomfortable. 

Is a fear of the dentist irrational?  I have to go, though, right?  My parents spent a fortune on braces ... I think I owe it to them to have a cleaning.  Sigh.

Diabetes, you force me to make responsible decisions sometimes.   Arghhhh!

July 03, 2008

Diabetes For The Day.

Working in a diabetes company means understanding the culture and responsibilities of a person with diabetes.  This is easy for me, because I'm a person with diabetes.  But not everyone at work is living with diabetes.  My fellow employees work with diabetes every, but they don't live with it. 

People at work have taken a very active interest in becoming more familiar with the diabetes lifestyle - more than just understanding the "facts" of this disease.  They ask questions about the pump, or different insulins, or what a CGM does.  They ask how things "feel."  One of my co-workers decided to have "diabetes for the day," which included him testing his blood sugar several times and wearing a pump infusion set (minus the cannula - just stuck to his abdomen for "the feel" of it) attached to a makeshift "pump."  He spent the day thinking about carbohydrate intake, blood sugar results, and the constant presence of a device, in efforts to better understand the community he's trying to help.  Here's his feedback:

Kerri:  How did testing your blood sugar affect the way you thought about food?

Co-Worker: 
I'd love to say that I'm a changed person and that I look at the world through different eyes having worn the shoes of someone with diabetes for a day.  Truthfully I think it was the inconvenience pain of testing that caused the greatest hesitation and re-jigging  for me.   The event that caught me most off guard was when I returned home from work and passed up having a cookie before dinner.  My inner dialog went something like,  "Mmm cookies.  Wait, I'd have to test first.  Kerri said I had to test before eating anything.  Hmm.  I'm going to be eating dinner in an hour so I'd probably have to test twice.  BUT.  If I have it with dinner, I can test just once ... I think I'll wait."

I have to say, all those fake sugars [note from Kerri - he's talking about artificial sweeteners] are really yucky and drinking mostly plain water is no fun.   Give me my plain sugar in my coffee.  If I had to inject insulin (saline) I think it might have really changed the way I thought about food because it would have forced me to do more calculations and understand what I was putting into my body (both the food and the insulin).  With just testing, I only had to make simple yes/no decisions.  Maybe next time I'll get wired up for a pump.  Shooting actual syringes saline ... am I getting paid to do this?

Kerri:  Did you ever feel inconvenienced by the presence of the meter or the "pump?"  How so?

CW: 
Having the meter/pump on my belt wasn't too conspicuous as I think it looked a lot like a geeky cell phone belt clip.  (And I'm pretty geeky.)  However, I did almost drop it into the toilet once.  Unlike a cellphone, it's wired/tubed to me which created a bit of a juggling act and not one you're likely to see at the circus.  Thankfully all my years of playing frisbee came in handy and I was able to prevent a very embarrassing accident.  (Since it was just a meter it wouldn't have been too costly.)

I also think that if I wasn't at a place where we talk about diabetes everyday, I might have been a bit more self-conscious.

Kerri:  How did the blood glucose numbers make you feel?  Did you associate any "guilt" to a higher number?  Did any of your results make you raise an eyebrow?

CW:
  Since I knew that my body could "handle" the swings I wasn't too worried and thus not too guilty.  (I had pizza for lunch and pasta for dinner ... and two cookies.  Something that I don't think would be part of a typical menu for someone who was managing their BG.)  I did have some pretty high swings and it did make me realize that keeping your BG within an acceptable range is not a passive act that can be programmed like a thermostat and left on auto-pilot.  There's a constant feedback loop that occurs and I don't think a CGM talking to a pump would be able to easily and reliably handle the delicate balance.  (And that's coming from a programmer.)

Kerri:  Do you feel as though  you have a better idea of what life with diabetes is like?  What else would you want to know?  What are you grateful for not knowing?


CW: 
I think what I experienced is just the tip of the proverbial iceberg.  I was forced to stop and think a few times, but I didn't have to pay the "penalty" of being careless and I knew in the morning it would all be over.  Sort of like playing with tasers without the batteries.  "Don't fake taser me, Bro!" 

I am a bit curious as to what a high and low are like.  Is it similar to being hungover?  Like having a bad flu?  Is it worse than a papercut between the fingers?  (I really hate paper cuts.  How can something so small hurt so much?  I'll inject saline before getting a papercut.)  The insulin pump is still very intriguing to me.  Can you feel the insulin going in?  Can you "feel" your BSL/energy change?

No amount of simulation will ever help me understand what it's like to not be able to just disconnect.  There is no vacation from diabetes.  It doesn't sleep when you sleep.  I can't even imagine that.  Even as I type this, the concept is so foreign to me.

Kerri:  Did this experiment make you appreciate your health any more?  Less?


CW: 
I've been very fortunate and have been very healthy all my life.  I have my scars and stories, but overall I can't complain.  I don't think the experiment changed how I thought of my own health.  I think I appreciate how amazing the human body is to keep everything working properly, but I don't think I'll change any of my habits as a result of the experiment.  Don't get me wrong.  I'll continue to watch my weight and try to eat healthy food.  (I haven't been to a fast food joint, except to use the bathroom, in over 15 years.)   But it's about my general health and well being, and not specifically as a way to prevent type 2 diabetes.

The experience will stay with me longer than the lancet marks on my fingers, but I would not classify it as life-altering.  Something well worth the time and I'd recommend that other participate in the experiment.

July 02, 2008

Dexcom Tips.

Dexcom and an old Trot Nixon shirt.  Almost classic.Last Thursday, my local Dexcom teaching nurse came to visit me here at dLife.  I think she's fantastic, but I'm also tremendously biased.  Little back story:

When I was first diagnosed, I was a little peanut of a kid.  My parents had no experience with diabetes or how to handle type 1 being a part of their child's life, so they looked for help within our town.  As fate would have it, one of my father's cousins (one of those once-removed cousins added to the family by marriage sorts of things) had a son with diabetes.  Jim was diagnosed when he was 18 months old, his mother, Eleanor,  was a registered dietitian and had spent time as both a diabetes professional and the mother of a kid with diabetes.  Perfect guide for my parents, right?  Right.  For years, my mother and I traveled to Joslin with Eleanor and Jim for our back-to-back endocrinologist appointments.  And when my parents would go on vacation, I would stay with Eleanor and her family because she knew how to take care of me.

So imagine my surprise when I find out that the CT/RI Dexcom teaching nurse is Eleanor!  Holy small world.  And holy long story, sorry about that.

Anyway, Eleanor came to visit me last week and brought me two spare Dexcom sensors.  We covered a lot of the technical bits about Dexcom'ing, as well as some tricks o' the trade.  My session with Eleanor helps me answer some of the reader questions I've received over the past few weeks.  Like these:

Q:  Can the sensor get wet?  I used the Dex3 and had to wear the shower patches.  They were terrible!


Yes, the Dexcom 7 sensor can be worn in the shower and the pool and any other soggy environment.  You don't need to wear those wild shower patches that eat your dermis anymore.  But here's something I didn't know:  When you are ready to put a new sensor on, you should clean the underside of the transmitter with an alcohol swab or similar.  I thought you weren't supposed to get this transmitter wet at all, but it turns out that a good swabbing can remove any soap residue, body lotion, or other random smudgy bits that may worm their way underneath.  This cleaning process helps retain the integrity of the transmitter.  

Q:  I've seen you wearing the sensor on your arm.  Aren't you supposed to wear it on your abdomen?

Ahem - according to the official Dexcom guidebook, "Choose a site on a fatty area of your abdomen (belly) to place your Sensor.  You can choose a site above or below your beltline. The best insertion areas are usually flat, 'pinchable,' and relatively free from where rubbing can occur (i.e., pant line, seatbelts)."  However, and off the record, the sensor can be worn anywhere there is a good amount of fatty tissue so you can grab the ol' interstitial fluid easily.  For me, I have a lot of placement options.  I've been wearing the sensor on my arm because that keeps it away from my waistline (I hate wearing any of these devices on my abdomen) and doesn't encounter much friction throughout the day.

Q:  You always talk about how you want your diabetes to be "seamless" and you've talked about how you hide your insulin pump so that it's not part of your wardrobe. So, my question is, how come you don't wear your sensor on your stomach or thigh?


This reader caught my recent dLife column, where I talked about some people staring at the Dexcom sensor on my arm.  This is a very good question. I wear the Dexcom sensor on my arm because it stays put there best.  The sensor is less apt to become peeled back and doesn't catch on my waistband.  It is also less likely to become loose and therefore irritating.  I don't feel comfortable wearing any diabetes devices on my stomach, and my legs are too muscular for the sensor.  Also, the sensor needs to be away from any insulin pump infusion set and from big pockets of scartissue.  So ... my arm is the best out-of-the-way location for Dex and still have it working correctly.  I'm trying to find the compromise between "external symptom" and "using available technology."  People stare sometimes, which makes me bristle a bit, but I would probably stare, too.  It's a different look for your average twenty-something.  ;)

Q:  Can you get more than seven days from one sensor?  Or are you just sticking $60 on your arm, getting a week from it, and then ripping that $60 off?  I can't imagine!

I haven't had the opportunity to restart a Dex7 sensor because the past few have melted off me before the seven day point.  On this last sensor, Eleanor applied some SkinTac on the sensor gauze and it has held steady through daily showers, daily workouts, and this blasted heat.  I have heard that you can "re-queue" a sensor by "pretending" that you've installed a new one.  I will give this a go next round.

Any other CGM-type questions?  Send 'em to kerri (at) sixuntilme (dot) com. 

EDIT:  Again, comments are being problematic.  Hopefully they're fixed now.  I need a new webhost, damnit.  Thanks for letting me know, Rachel! 

July 01, 2008

CGMS: Denied.

I submitted the paperwork when I applied,
But my CGM coverage was flat-out denied.

All that we want is the option to choose
What kind of dManagement tools that we use.
The technology works and it's there, on our side.
So why would requests be rejected, denied?
It's not like we're asking to have legs removed.
Instead, we are hoping our health is improved!
It costs them some money, this investment in health
But of course it becomes more a question of wealth.
These machines could save lives - does that count more than cash?
Or would companies rather see us burn and crash?

I just want the option to sleep through the night
Without lows creeping up and holding me tight.
Or the chance to see graphs that show my sugar trends
So I know how to best tweak the insulin end.
I want to be healthy.  I want to be sure
That my numbers are stable, my safety secure.
I'm a daughter, a sister, a friend, and a wife.
The investment is small when compared to my life.
I enjoy some "good fun" and I'm healthy today
And a CGM tool can help keep me this way.

When it comes to our lives, there is a clear choice.
We deserve all the options.  We must raise our voice.

For more information, click here!
 

Visitors since November 7, 2005