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April 18, 2013

Slammed.

So this was last night: 

It's like a big dipper.  Of shit.

Went to bed after a little bit of a spike, bolused it down conservatively because I was going to bed, but then woke up at 4 am and saw a steady, red line on my Dexcom graph, showing that I was not only in the blood sugar trenches, but had been there for a while.

The problem is, it wasn't the low alarm on the Dexcom that roused me from sleep.  It was the sound of my daughter yelling, "MOMMY AND DADDY!!!" through the baby monitor (which I will use until she's at least ten thousand years old) that vaulted me from the bed. 

This is a problem, and one I've always had with the Dexcom alarms.  They are great - and plenty loud - when I'm awake and driving, or playing in the garden, or on run.  I have no trouble responding to them when I'm wide awake and tuned in.  But when I'm asleep, and low, those alarms rattle on without a response from me.  And that unnerves the eff out of me, because nighttime lows are what I want the Dexcom protecting me from the most.  

I've done the Dexcom-in-a-glass routine, and I'll revisit that strategy again tonight (I took a break from it after switching to the G4, as the alarms were notably louder than the Seven Plus), but these kinds of lows make me nervous.  I don't respond to them as well as I used to - last night's low made me feel like every move my body was making was through a pool of thick, overcooked oatmeal, putting a definitive drag on my muscles and my mind.  Once I had a few glucose tabs (and confirmed the low at 49 mg/dL), I still needed a hit of juice to push that sloggy, thick feeling away from my synapses and give me the wherewithal to go back upstairs to bed.  (Where there was a three year old recovering, post-nightmare, and hanging out with her dad.)  And once the low is over, I don't bounce back the way I did years ago, either.  A blood sugar under 60 that makes a middle of the night visit wrecks me up a bit until I'm well into my second fifth coffee the following morning. 

This morning, thanks to lows and nightmares and the quiet of a house that isn't overrun by singing, springtime birds nesting outside of our bedroom window, the whole family managed to catch a little sleep-in.  But I feel slammed, and sometimes I wonder how many of my brain cells are surrendered during those graphed red lines. (As evidenced by the fact that it took me three minutes to remember how to make pancakes this morning, and it took me 30 full seconds to find my insulin pump, which was attached to me, what the eff.)

March 19, 2013

Surface Tension.

Maybe it was because one afternoon had me running outside on the trail near my house (in shorts, mind you) with daffodils threatening to bloom any minute, and the next day I was walking through Providence with gloves and a wool coat and the desire to light myself on fire in efforts to thaw.  Did this shift in weather, bouncing from almost-spring to definitely-winter aggravate my sensitive skin?  (I'm a delicate flower, damn it.) 

Whatever the reason, any surface area of my skin that has come into contact with a Dexcom sensor or pump site adhesive in the last three months was suddenly, and painfully, inflamed Sunday and Monday.

I noticed it first on Friday evening, after being out in Providence for a few hours, walking long enough outside to give my hands that "Hey, you're a 108 year old woman!" chapping.  A repeat performance on Saturday had me itching recklessly at my Dexcom sensor, despite the Toughpad that anchored it to my skin.  And Sunday morning, after taking a hot shower, I noticed that there were egg-shaped patches of skin, perfectly matching the shape of a Dexcom sensor, raised and itching on my thighs.  These patches were accompanied by smaller circles matching my infusion set adhesive, dotting along the back of my hips and my arms.  

And the itch?  Oh the freaking itch!  

"Holy ... is that from your sites?" Chris asked me on Sunday night, seeing the patch on my arm that you could roast a marshmallow over.

"It is.  But dude, it was from like December. I don't think I've had a Dexcom sensor on my arm at all this year.  It's crazy inflamed right now, and I have no idea why."

"The pump site right near it looks itchy, too," he said, circling me and noting the patchwork of itchy bits and robot parts. 

"Itches like mad."

These matchy-matchy moments don't happen often, so damn it, I'm photographing them.  Also, what do you think a hedgehog looks like, naked?  I bet flubby.

It's been three days, and the hot rashes (sounds so much sexier than it actually is) have calmed down, but only after I peeled off the Dexcom sensor (underneath it was just a touch prickly, but the edges were on fire because they had touched where previous sensors rested) and only after I rerouted a new pump set.  (And after slathering my sites with anti-itch creams and hydrocortisone treatments and basically the entire "Itch!" aisle at CVS.)  I'm convinced this reaction was a response to the weather change, and how cold weather makes these rashes far worse. 

But now what?! I have these makeshift solutions for the sensor, but my skin needs to heal before I can give any of these a go again.  And now my pump sites are causing hives?  A blustery winter weekend is enough to set my dermis back a few months?  I've had issues with adhesive itch in the past (click here for a gross photo from a few years ago), but nothing like what's cropped up since late August. 

I thought about ripping the Dexcom off and letting my skin breathe for a few weeks.  And then a symptom-free 53 mg/dL slapped me across the face while I was alone with my kid, and that shook my senses loose again.  The tighter my blood sugars run, the crummier my hypoglycemic unawareness becomes.  I am not willing to take the risk on either side. 

I'm longing for summer, when my skin will (hopefully) relax and I can resume my robotic tendencies without all of this surface tension and bid a hopeful farewell to the itch.

[Dexcom disclosure]  

March 06, 2013

Not Subtle.

New running tights +  Dexcom G4 sensor = holy bulge in my pants.

This Dexcom sensor is more accurate, the range is way better, but the higher transmitter profile still works me over a bit.  Thankfully, I'm so graceful that I never knock it against it door jams.  Nope.  Never.  Always graceful.

March 04, 2013

Scalped?

Over the weekend, I posted this photo to Facebook:

Not my skin.  Because wouldn't there be a LOT more blood?  :)

... with the caption:  "Day 7 of a Dexcom G4 sensor, mounted on a Toughpad, stuck to my thigh. This is what it looks like after removal: like I scalped myself."

And after reading through a few of the comments, i realized that some people took me a touch too literally with this one.  :)

This is a photo of the Dexcom G4 sensor, stuck to the top of a J&J Toughpad, as I mentioned in this post.  At the "CHANGE SENSOR NOW!" all caps warning that pops up on the receiver screen at the close of day seven, I pull the sensors immediately.  (As much as I want to leave a still-sticking sensor stuck, I'm afraid to instigate a rash, so don't wear my sensors past seven days ... and yes, it makes me crazy to pull a perfectly good sensor.)  When I pull the sensor up, with it comes the Toughpad.  And grossly enough, the Toughpad looks exactly like my skin.  Which makes it look like I am pulling up huge patches of skin when I remove the sensor.

Ew!  No!  

So, to clarify:  That's a photo of a sensor on a band-aid, basically.  Not my skin removed from my body by way of blowtorch (which would explain the singed edges?).  Dexcoms aren't a scalping device. 

Carry on.

February 20, 2013

Dexcom Rash: Alternative Solution.

The Dexcom rash is under control, but still not gone.  So I'm still on the hunt for something that makes this rash feel less like I'm developing a skin-peeling, borderline-chemical burn looking mess underneath each sensor adhesive ring. 

The inhaler solution works really well, but there is the risk of putting a steroid on top of my skin.  (My doctor yesterday and I had a long discussion about the adhesive rash, or "contact dermatitis," as he's fond of calling it, and he cautioned me against long-term use of the inhaler solution because it could cause permanent discoloration of those patches of my skin.  "I don't want that," I said, "but I do want to find some solution to this issue.")

Thankfully, about two weeks ago, I gave one of these a try:

TOUGHPAD!  Yaaaaaw!!  (Howard Dean-style yell there.)

This is a Tough Pad.  (The name conjures up a mental image of the padding on the underside of a lion's paw.  Rawr.)  They're made by Johnson & Johnson, and I ordered a package of them off of Amazon after a reader emailed and said they were the solution that worked, rash-avoidance-wise, for them. 

The Amazon description reads as follows:  "These super durable Pads are designed to stay in place for over 24 hours, are extra flexible to fit over joints, and are 100% Waterproof and Sweatproof. Johnson & Johnson Red Cross Brand Tough Pads act in place of a scab to encourage fast natural healing. They're made with Compeed Moisture Seal Technology which helps form a gel cushion over the wound to cover painful nerve endings and protect from bumping to help minimize pain. Tough Pads are super durable and waterproof to stay on longer and keep your wound protected." 

So it's a wound coverage thing, but I'm using it a touch differently.  I'm still wearing my Dexcom sensors on my outer thigh, only now I'm plunking down this adhesive Tough Pad thing first.  (Where?  Image standing up straight, and then let your hands hang down by your sides.  Where the palm of your hands rests on your outer thigh?  That's where I'm shoving the sensor in.)  Once the Tough Pad is in place and it's smoothed out, I stick the Dexcom adhesive right over it.  The Tough Pad is long enough to cover the entire length of the adhesive, and more than wide enough to cover the width.  And I just deploy the sensor wire right through the Tough Pad.

I used one two weeks ago, for the first time, and I did not have a skin reaction to it at all.  (The only reaction I had was when I decided to stick a slip of Opsite Flexifix along the edge, once it started to peel.  Even though the Opsite doesn't usually give me a reaction, my skin was a little pink when I pulled the whole set up off.)  My accuracy throughout the life of that first sensor was completely fine and normal, as though there wasn't a skin barrier at all.  And for this second round, of which I'm on Day Four, the song remains the same:  no rash, no accuracy issues, and the only thing I'm being careful of is prematurely peeling back the Tough Pad (because once that adhesive gives up, the whole thing is shot).

I hope this is a solution that can work for me, long term and drug-free, while my doctor and dermatologist and I experiment with other solutions.  Because the Dexcom woke me up twice last night with gross, sustained lows, and I'm not willing to give this device up because of a rash.  I'm itching to make it work.

(Bah-dum-dum?)

Gross lows.

[Dexcom disclosure

February 13, 2013

Down the Stairs.

What, you didn't want to eat the glucose tabs sitting right there, on the bedside table?  WTF IS WRONG WITH YOU?It was a weak alarm, but I still heard it.  I forgot to take the Dexcom receiver out of its case before I went to bed, so the vibrations weren't directly against the wooden nightstand, but the repeated BEEEEEEP!ing was enough to rouse me, after about fifteen minutes. 

"LOW BLOOD SUGAR UNDER 55 MG/DL GET THE HELL OUT OF BED" the screen screamed at me.

"Sure, yeah."  

I clicked my pump (aka 'my watch') to see what time it was - 2:32 am - and I tried to run my hand through my hair to get it out of my face, but my fingers ended up stuck in the mess of sweat-matted, tangled hair.

The lamp switched on after some fumbling, and I stood up gingerly, removing the brace from my foot (thank you, plantar faciitis) so I could walk.  The walls of my bedroom seemed like they were throbbing and pulsing, like I was standing inside of someone's beating heart.

My meter showed me a "34 mg/dL," like it was a prize I won for being so sweaty.

Despite the bottle of glucose tabs on my bedside table (open, and ready, but ignored), despite the sleeping and capable husband in our bed, and despite the fact that I was walking on a compromised and even-more-clumsy-than-usual foot, I decided to go down the stairs to get juice.

Foolish.

And despite the fact that I actually looked at the juice bottle to calculate (ha?) how many carbs would be in a glass, I still drank too much of it.  And then, fueled by adrenaline and bad decisions and the desire to not feel like the kitchen floor was made of shifting sand, I also grabbed a handful of gum drops from the bag in the fridge.Not smart.  Not even a little bit smart, especially because as I was chewing, I was calculating a correction bolus for the overtreat, but then forgot to dial it into my pump.  It was a perfect storm of bad decisions, with a brain slogging through hypoglycemia at the helm.

Such a strange hypoglycemic aftermath: put the juice glass in the dishwasher and then, for whatever reason, decide to finish loading the rest of the dirty dishes in and set the dishwasher to cycle, then go upstairs to blow dry my hair in an attempt to ward off the chills that were already setting in from too long in damp, low-sweaty clothes, then brush my teeth, then check on Birdy to make sure she's okay ... what prompts this routine?  Is this the way my body calms down after being jolted from sleep by panic?  

After about 45 minutes, I felt normal.  I saw 99 mg/dL and an arrow pointing up, so I figured I was safe.  

But the rest of the night was spent listening to the Dexcom BEEEEEEEEP! because my blood sugars were cruising up, up, and away, ready to greet me with a "HIGH!" in the morning. (That, and Siah was nose-to-nose with me this morning, which made me happy and grossed me out, all at once.)

I should have just stayed downstairs and started my day at 2:30 am, because there wasn't going to be any sleep after that moment, anyway.  Besides, there's someone always awake in the DOC, isn't there?  All hours of the day?  

* You don't keep a bag of gumdrops in the fridge?  Just me?  They were on sale at CVS. Happy Valentine's Day?  Go spare a rose instead.  Gumdrops are the devil's work.

January 25, 2013

Dexcom G4: Finally, a Case.

When Donna from Tallygear reached out a few weeks ago and offered to send one of her Dexcom G4 cases for me to try out, I was all about it because I almost drop the receiver onto the tile bathroom floor, the hardwoods in the living room, the icy driveway, and the concrete sidewalks going into the gym at least once a day ... for all of these surfaces.  I'm not very graceful, and when you add gloves to the mix (necessary in this arctic weather that my daughter accurately described as "a snowman's breath"), I'll fumble even my most precious of possessions.  (Note:  Birdy holds hands with me and walks on her own.  She's safe.)

The Dexcom G4 system is more accurate than the previous iteration, but it's definitely not sturdier.  Or at least I'm afraid to find out just how delicate the receiver is.  The old system was a big, fat egg and its round edges (and convenient silicone protector) made it seem more like a softball than an iPod.  But this new receiver - sleeker and sexier and far more the modern day device - also seems more breakable.  The big screen, the flat edges, the lack of a protective case.  (Okay, the new receiver does have a protective case, but it's about as bulky as smuggling a fistful of those Keurig coffee cup things underneath your shirt. Not streamlined in the slightest, and also, I don't wear a utility belt during the course of my day job so clipping it to something is a pipe dream.) 

Which is why I was excited to try the Tallygear case for the G4.  I was using this:

Here is my scratched up dining room table.  In other news, I need to dust.

... and it worked fine only it was bigger than it needed to be and I couldn't see the Dexcom graph unless I took the receiver out of the pouch.  Now I'm using these:

Love.

... and it's a nice, tight fit around the receiver, gives it a bit of extra cushion in case it falls (or if I happen to throw it if it BEEEEEP!s to tell me I'm high in the middle of the night and then tells me again, every fifteen minutes, for good measure), and I can see the graph through the plastic window screen (and I can also press the button through that screen).  While I'm still longing for the silicone case that wrapped tightly around my old Dexcom egg receiver, this Tallygear case is an excellent interim.  

The little clippy things that I can use to clip the case to the inside of my purse, to my belt loop, around my wrist, etc. are also very useful.  It also has a loop on the back of the case if you want to toss this thing onto your utility belt, Batman.   

You can purchase this on the Tallygear website for $18.95, and there are a ton of different color options.  You don't have to be as boring as me and go for basic black (I'm calling it "Darth") or purple (Grape Ape?).  The bright yellow is pretty badass.  And if you use the "DexG4" coupon code, you'll get 10% off your order.  

[Disclosure:  I received this case for free, I didn't promise to write a review, but I decided to anyway because I have been itching to find a G4 case that I like, and this is a good start. So I wanted to share.  I need to protect that receiver from my klutziness.]

January 07, 2013

Clotted Dexcom Sensor.

(That's easily one of the grossest blog post titles I've had in the past seven and a half years.  Clotted?  Blech.  Sorry about that.)

Last week, I needed to give the real estate on my thighs a little breathing room, so rotated my Dexcom sensor up north to live on the back of my right arm for a few days.  Chris helped me out with the sensor application, with me preparing my skin, sticking the adhesive patch where I want it, and then asking him to, "Oh, do it carefully okay because it might pinch a little and ..." as he unclips the sensor applicator after half a second and says, "It's done."  (When I'm not controlling the needle, I bug out.  Pain management control freak, right here.) 

"Oh shit ... it's bleeding," he said, looking down at the sensor sans transmitter, and we both watched the space beneath pool with blood.

"Eh.  Hopefully it still decides to work.  Can you snap the transmitter in, and I'll fire it up?"

We finished up our respective tasks (he winced when he clipped the transmitter in, expecting it to hurt me, and I queued up the new sensor.  And for a week, this thing gave me spot-on results.  Meter said 183 mg/dL?  The Dexcom gave the exact same result. Meter claims 89 mg/dL?  The CGM confirmed that number, along with the added clue of a downward sloping arrow.  This sensor was, by far, the most accurate one I've seen for the G4.

Which is why I was so surprised (and horrified) to pull the sensor out last night and see the nastiest blood clot stuck on the end of the sensor wire, and dried blood pooled in the sensor base.

Oh effing EW.

(This post has officially become a gross post ... a "grost.")

My faith in the G4 is now that much stronger ... even when I'm working with a clotted sensor, it still fires out some on-point results.  Now if only my pancreas would get on this "I work despite being slightly compromised" bandwagon ...

December 13, 2012

Dexcom G4: The Airport.

My experiences at the airport are all anecdotal, so while I assume that TSA teams have seen insulin pumps and CGMs before, I'm most likely completely wrong.  Maybe they think I actually do have a suspicious device on hand, and they want to check it out thoroughly.  Maybe we're just going through the motions, according to protocol.  Either way, I don't mind being pulled aside for the pat-down (unless I'm trying to make a connection flight, in which case I tweak out the entire time, wringing my hands until they're useless dishrags with bitten fingernails.)

The trip to Australia was my first experience at the airport with the Dexcom G4, and while it wasn't too much of a hiccup, it was a different experience than traveling with the Dexcom Seven Plus system. (Note: Australia was the first, and only time, so far, that I've traveled with the G4. I wonder how the next trip will go.)  The people I ran into, security-wise, looked at this device as though it was made out of live gerbils, so it took a while to move through the line.

But I was a little surprised at how many people were called in to examine the G4:  the "female assist!", supervisor, and then the security supervisor.

I didn't take a photo of the Dex at the airport, because I would have most likely been arrested.

"Um ... what is that?"  

"This is a diabetes device, kind of like an insulin pump."  I wanted to mention a device they might be at least a little familiar with, before launching into an explanation including weird words like "interstitial."

"I need you to stand over here, miss, and do not touch any of your belongings."

Chris was watching from a few feet away, keeping an eye on our bags as they went through the x-ray machine. 

"I'm going to just stand over here for a few minutes with my shoes off, okay?"  I said to him, holding up the Dexcom receiver as evidence of probable cause.

He waved and nodded, safely back in his shoes and reunited with our bags.  The security team continued their questioning as they swabbed the device and proceeded to pat me down.

"A diabetes device?  Okay, what does it do?" asked the supervisor.

So I explained the sensor and the transmitter, and how it pulls glucose values from the interstitial fluid in my body, then transmits the data to the receiver.

"So it's for blood sugar management?"

"Yes."

"Does it play music?"

Wasn't prepared for that question.

"No?  Well, when it alarms when my blood sugar goes too high or too low, it plays a tune.  But not like a real song - more like an irritating commercial jingle."

"Does it communicate with your computer or phone?"

"Nope."

He paused.  "Does it come in different colors?"

Odd question. "It does, actually.  Pink, blue, or black."

"Pink, eh?"  The TSA supervisor examined the receiver one more time, then asked to see the sensor on my leg one more time.  (Thankful for yoga pants, which are easy to hitch up to expose the necessary real estate.)  His team also took at look at everyone one last time, making notes on a small iPad looking device.  Then the security machine buzzed, letting them know my device didn't contain any explosive materials.  I was free to go.

"So, do you like it?"

That stopped me.  "Like it?"

"Yes.  Does it help?"

"It does, actually.  It helps me keep tighter control of my blood sugars, which helps everything."

"Thanks for your patience."  He handed me back the receiver, turning it over in his hand one more time.  "My niece has diabetes, and she has a pump, I think.  She might like to hear about this thing."  He smiled.   "She likes pink."

December 05, 2012

Dexcom G4: Exercising my Demons.

There aren't any stupid questions. Or so I was told by every teacher in every classroom, growing up.  But I think the Dexcom is the exception to that rule.

Because when it asks me "???" with that blank look on its screen, I can only throw my hands in the air and say, "WHAT? What is your question?!"

With the Seven Plus system, I had my fair share of the Triple Question Marks.  Usually they signaled that a sensor was about to give up, or that something else was en route to borked.  But for the last month on the G4, I hadn't seen the dreaded triples. 

Until last night. 

WHAT IS YOUR FREAKING QUESTION???  ?????????????

While I was at the gym, with the Dexcom receiver sitting safely on the treadmill shelf, the receiver showed the "lost signal" icon.  Which, according to sources, means that I'm "out of receiver range," meaning I'm too far from the receiver, meaning I'm not even close to it.  Meaning that I'm totally confused because the transmitter and sensor were less than three feet from the receiver when it claims to have lost the signal.

Meaning that I was extra frustrated when my meter showed a 50 mg/dL before driving home after my workout.  Symptom-free lows plus a questioning Dexcom receiver equals frustration.  (That's pretty much the only kind of math I can do, right there.)

This has happened a few times for me at the gym, while on the treadmill specifically, but the Dexcom usually "finds" me soon enough and my numbers reappear on the graph.  Last night, however, the Dexcom oscillated between the lost signal and triple question marks for my entire workout.   And it didn't sort itself out until about midnight ... five hours after going rogue. 

But all night long?  Totally fine.  And all day, so far?  Also fine.  Is it the treadmill that's making the G4 go berserk?  Does the new system hate running?  (I can't blame it, if that's the case.  I hate running, too.)  Is this sensor a fickle one?  Does this happen to other people while they're at the gym?  Is it the friction of my clothes against the transmitter?  Is it something about the treadmill itself?  What can I do to prevent it? Will Batman escape the machine before being turned into mashed potatoes? 

Or is that just a stupid question?  (???)

November 27, 2012

Dexcom G4: Second Impressions.

It's been three and a half weeks since my transition to the Dexcom G4 system, and I've finally burned through the first box of sensors. (Because I live in fear of the frigging rash, so I immediately pull a sensor once I hit the seven day mark, and I also had to pull one early because I scraped it off while traveling. Going forward, I expect a box of sensors will last me 28 days.) With the first month behind me, I have a few updates to my initial impressions.

The Receiver.  The receiver is still badass. I really do love the smaller size, especially for things like going to the gym. It fits neatly into my meter bag, and it's not this gigantic, intrusive device that I have to whip out at meal times. It's discreet and looks like any other modern device of the 21st century (dagnabit).

The Transmitter.  The f&*k? This thing is big. It's weird how it's "just a little bit bigger" than the old transmitter, but I notice the difference often, even after a month. I ran into this same problem when I switched from the Minimed to the Animas pump. When you're wearing a device every, single day, you become used to every aspect of it, from the curve of the corners to the way the pump clips sticks up ever so slightly ... you know the shape and the experience of it by heart. Which is why the new transmitter is mucking with my head, because it's a whole new set of angles and curves to adjust to. Even though I know the G4 is progress in the right direction, for this CGM, I do not like the new transmitter for it's size.

The Alarms. I do really, really like the alarms. They're louder. The low and the high one sound completely different from one another. The receiver-in-the-glass trick still works fine. I remain a fan of the G4 alarms.

Accuracy. Being 100% honest, the accuracy for me on the G4 isn't great in the first 24 hours. I rely on my glucose meter and fingersticks for that first day (the four I've experienced, so far, anyway), and I see numbers on the Dex that are sometimes as much as 80 points off from where I'm actually clocking in. However, I hope that changes as I move forward, and maybe the first few sensors had some issues in my body. I'm willing to let the first 24 hours fly because the accuracy going forward is scary. Spot-on. I see my meter and the Dex as almost mirror-images of one another, often only off by a handful of points. I see matchy-matchy numbers several times throughout the week. After the first day, I trust the G4 implicitly. And that's a really useful thing, especially as I add more miles to my workouts and have very unpredictable sleeping schedules. (Note: The photo below is from day one, Hour 8 of a new sensor. Maybe things are changing for the better in those first 24 hours?)

And this was Day One. Maybe the tide is turning?

Randoms. The carry case provided by Dexcom looks more like something fit for Man vs. Wild (Bear Grylls is a fox, which makes this too many animals in one sentence aside.) than for life. I am looking forward to the silicone cases that I'm sure are coming for this receiver. Hopefully they arrive before I drop this thing onto the bathroom floor and it shatters into a thousand expensive pieces. Also, I still think the battery life is excellent, and I've charged it only three times in the last four weeks. (That's big, since I LOVE to click the button and look at the graph.) I've yet to download anything to the software (because I have a Mac) or to Diasend (yes you can ... more on that in a bit), so I don't know how that shakes out yet, but I'm curious to have fifteen minutes to myself to find out.  (See also: Birdy starts "school" this week, wherein I plan to reclaim my inbox.) (And this is the end of my parenthesis excursion.) (Or is it?! Dun dun duuuuuun!)

First impressions are behind me. Second impressions are logged. Hopefully third impressions include "Hey, the accuracy improved in the first 25 hours!" and "Wow, what a lovely case for the Dexcom that keeps it safe from Sparling-inspired destruction!"

[Dexcom disclosure]

November 06, 2012

Dexcom G4: First Impressions.

I was nervous about receiving the Dexcom G4 because of my issues with the itchy rash, but now that I've found a fix (so far, at least), I was ready to open the package from my partners in San Diego. 

The Receiver.  Very first impressions?  It is SO MUCH SMALLER.  The shape is that of my glucose meter, and I prefer it. Though I never had any issues with The Egg (I sort of have a special, egg-shaped space in my heart for it), I do like a smaller receiver.  It's fly.  (Do people still say that?)  And smaller.  Smaller is better, for me, when I'm trying to carry several other diabetes items at once.  The G4 receiver fits into my meter case, which is very convenient.

It also has a color screen.  At first, I was "eh" about the idea of a color screen, because I didn't see how it would make a difference to me, but for that cursory glance at the screen, it does matter.  Anything "above the line" is yellow, within range is white, and below the line is red.  With a quick glance, I can see how long I've been in, above, or below range.  And having the hypos as red works for me, because it's the most serious issue I face throughout the day.  (Also, it's a nice change from the Seven Plus readout, which looked more like an old school Gameboy, whereas the G4 looks more like an iPod.)

The Transmitter.  The range of the new transmitter is truly remarkable.  I can leave my receiver on the kitchen table and go outside to rake leaves way out in the backyard, and the thing keeps the signal.  I'm still testing how far I can go.  :)  The G4 transmitter is completely different from the Seven Plus in that it's a lot taller, so the profile isn't as streamlined on my body.  Even though the sensor looks almost exactly the same (even though it has some subtle differences, like the gauge of the insertion needle is thinner and therefore more comfortable), the transmitter anchors in with a much higher profile. 


This isn't a huge deal, but it's the most noticeable on-body change for me so far.  I wear my sensors on my thigh, so in regular clothes, it's not a big deal.  But in my gym clothes, which fit snugger against my body, the bulge in my pants is more of an issue.  (And WOW that's a sentence I've never written before but now I can't unthink it or unwrite it so there you go.)

The Alarms.  The alarms are amazing because they are different for low and high alerts.  DIFFERENT.  This has been something Chris and I have been discussing for ages.  Sometimes, when the Seven Plus was alarming, Chris couldn't tell if I was low or high without reaching to the bedside table and clicking the screen alive.  Now he knows what end of the spectrum I'm at just by the alarm.  This is brilliant.  And long overdue, in my opinion.  Also, the alarms can be set to vibrate, soft, normal, attentive (this is where I have mine set, because they're musical), and hypo-repeat.  When I'm low, the notes of the song go from high to low, and the reverse applies for the high blood sugar alarm.  This is such a nice change because I know immediately what kind of issue I'm reacting to, without even needing to click the screen.  (And to that end, it takes an extra second or two for the screen to come alive when I hit the button.  I'm not sure what the delay is about, but it's not as fast as the Seven Plus.)

Battery Life.  Just as a note, I've been wearing the system since Sunday, and I haven't had to charge the receiver yet.  It's not even halfway down in battery life yet.  This is a marked improvement from the Seven Plus, which I had to charge every other day.  Also, it charges through a USB cord, so now I can pack fewer cords when I travel.  Thank goodness, because my suitcase was starting to look like a giant electric spider was trying to escape it, upon unzipping the compartment I store my cords in.

All-Important Accuracy.  So what about accuracy?  The G4 claims to be more accurate, but I can't make that nod yet.  I've only been wearing the new system for a few days, so I don't trust it yet.  We're still in that "getting to know you" phase of our new relationship (even though I've already jumped into bed with it).  I've had some moments I'm really impressed with, like the seven hour block where my meter and the Dexcom were never off by more than 10 points, but I've also had a WTF moment, like when the meter said 188 and 180 mg/dL (double-test), compared to the 64 mg/dL on the Dexcom.  They did catch up to one another about twenty minutes later, but still.  This is what is most important to me, and I'll be writing about the accuracy in more detail after I clock a few more days with the G4.

I want this new system to be exactly what I've been hoping the next generation would be:  fast-becoming a replacement for many of the fingersticks I do throughout the day.  Time will tell.  In the meantime, I remain grateful for technology that serves as a safety net while I'm driving, exercising, sleeping ... living.

[Dexcom disclosure]

November 02, 2012

Dexcom Rash: Swinging for the Fences.

The Dexcom rash wasn't fixed by Opsite Flexifix tape underneath it as a barrier between the sensor and my skin.  Alcohol wipes after showing/before applying the sensor didn't work, either.  Neither did using a hydrocortisone cream, or Skin Tac, or Cetaphil soap.  Dexcom, regardless of what I threw at the sensor, continued to act rashly.

And this is where a reader came in with a suggestion that saved my skin.  She wrote, "You need to spray steroid asthma inhaler on the site after the alcohol or iv prep and before you insert."  She also attached a photo of a rash she received from a CGM and it looked just like mine.

Oh Internet ... I love you big time.  

It took some research, and several phone calls/visits/consultations with my PCP, dermatologist, and endocrinologist, in addition to phone calls to the Dexcom hotline o' bearded service (shout-out to The Hammer) to lock down a prescription for a steroid inhaler (the conversations about this off-label application were long and intense), and this morning marks the 36 hour mark with a sensor. 

Without a rash.  

"And there goes the ball ... right over the fence ... home run!!!" 

*Crowd goes wild.  Or at least Birdy claps her hands and the cats don't throw up, for once.*

Just as the fabulous reader (my hero) had suggested and after discussing the option at length with my endocrinologist, I showered and dried off, and then sprayed the inhaler spray against my clean, dry skin.  (It surprised me when it came out as a kind of powdery substance and not a mist.)  I sprayed it about three times to cover the anticipated surface area of the sensor adhesive.  After about 30 seconds, when my skin seemed dry, I placed the sensor on like normal and deployed the needle.  The adhesive patch felt a little stiffer and cracklier than normal, but the following morning, it was smooth and pliable against my skin, like it usually is.

But the best part is that after 24 hours, I wasn't itchy.  And this morning, at the 36 hour mark, the adhesive edge wasn't ringed with the red, puffy, reactive skin I've become used to since the end of August.  I'm not sure where this adhesive allergy came from in the first place (and for those who asked, no, I'm not pregnant), and I'm not sure why the inhaler steroid is battling it, but it is.  And honestly, after so many weeks without a proper Dexcom safety net, I don't care why it's working.  I'm just thankful that it is, and that my medical team is on board to try some different things in efforts to keep me safe.

Mystery rash cured, hopefully!

Note:  This is not medical advice.  Please don't try this without consulting with and getting clearance from your medical team.  I'm just sharing anecdotal information about something that worked in my personal diabetes life.  Nothing I ever say should be taken as medical advice because if I was really useful, I'd have an A1C of 5.7% and I'd burp rainbows.

(Second Note, for Monica, who may be reading this post today and who I know hates sports analogies.  "Swinging for the fences" means "attempts at doing difficult or near-impossible things," or at least according to Urban Dictionary.  You're welcome.  Oh, and this is also for you.)

October 22, 2012

Trying Again.

I have missed my CGM.

Over the last few weeks, I've pulled back considerably on my Dexcom use, solely because of the crazy rash that was cropping up underneath the sensor sites.  (And a quick Google search confirmed that I was not the only one who has gone through this issue - Lorraine at This is Caleb had a very informative post about Caleb's similar reaction, and also had some tips on mitigating the issue.)  This rash has been an issue since I was in San Diego at the end of August, and after trying different skin locations, application methods, etc. to the max (to the max, yo), I ended up taking the sensors off completely a week and a half ago.

I did a removal/long break because my skin needed a "full heal" first.  My preferred sensor spots, on my outer thigh, were red and scaly from repeated pockets of itchy rash, and they needed to mend entirely before I felt comfortable slapping another sensor on there.  (And yes, I have tried other locations for my sensors, but have had the same reaction.)  But, thanks to time off from the adhesive/transmitter and the rapid-healing baby lotion that we use for Birdy's sensitive skin, my sites were soon back to normal. 

The first few days of the Dexcom "forced vacation" were particularly crummy, because I have been so used to the steady stream of data over the last five years.  I didn't like not being able to check the receiver before I did certain things, like after breakfast or getting behind the wheel.  Even though I could always check my blood sugar using my glucose meter, it wasn't the same kind of reassurance as when I could see the number plotted within the graph of "where the hell it's been and where it's going." 

Using this photo again because I love, love, love this graph.  "Makes me feel potent."  Which is a great line from "Dead Poet's Society."  Which is a great movie.  Holy digression.

But there are two moments when the Dexcom means most to me:  during exercise, and before bedtime.

The Dexcom during workouts helps me figure out how to best stay active as safely as possible.  I feel confident jumping onto the treadmill for a run if I'm 119 mg/dL with an upward-sloping arrow, but I'll drink some Gartorade if I'm 119 mg/dL with a downward-pointing arrow.  And if I have a 119 mg/dL with two double-down arrows, I'll delay the workout and hit some glucose tabs.  It's not about the number, for me, but the context.  

And before bedtime has been dodgy, for the same reason.  I hate not seeing the mg/dL "breadcrumb trail" before going to sleep.  I didn't realize how reliant I was on the graph until I didn't have access to it.  This is uncomfortable for me in my own home, but when I'm traveling, it's reason enough for a 3 am wake up call to test my blood sugar.  The past few weeks, with excessive amounts of travel and a variance of time zones, have made me miss, and appreciate, the Dexcom even more.

Today, I'm giving it another go.  I'm hoping that the sensor, applied to healed skin, will not cause the itchy, hive-like rash I've been experiencing since late August.  (Because nothing says "hey, I'm healthy!" quite like aggressive, weeping rashes.)  I'm hoping I can return to regular Dexcom use, without this weird reaction.  I'm hoping to return to normal, with the sensor hanging on for as long as it can, instead of me ripping it off so I can rake my nails across the skin in relief.  As you might be able to guess, I'm wicked hopeful.

I have missed my CGM.  

Let's hope it missed me.  :)

September 17, 2012

Sticky Issues.

Last week and in pursuit of keeping the skin rashes at bay, I tried a new Dexcom sensor on my thigh, but instead of placing it directly against my skin, I put a piece of that Opsite Flexifix tape underneath the sensor (cutting a teeny hole out for the Dexcom wire insertion), and sticking the sensor to that instead of my actual skin.

And for the first few days, I was all, "Ahhhh!" because it seemed like it was a solution to avoiding the itchy, burning rash.

And then, I was all *scratch, scratch,* because the sensor was somehow affecting my skin, even with the tape as a barrier.  I gave the site a full seven days, but as soon as it beeped "Change sensor now," I gratefully ripped the thing loose.  Underneath, the rash wasn't too raw (not nearly as raw as the first one I experienced), but it was prickly and bumpy and if I let my brain think about how much it might possibly itch, I wanted to scratch my leg down to the bare bone.

Gross.

So I'm trying two new attempts this week:  the sensor is up north, on my arm, and I also applied a layer of Benadryl spray to my skin before slapping on the new sensor (per the recommendation of several very clever people, to whom I shall send balloons and jellybeans to).  So far, since last night, not a whisper of an itch, and the sensor is giving me very good results.  Will this work because of the Benadryl?  Or because the sensor is in completely new skin real estate? Did I get a batch of sensors that I'm reacting strangely to? 

Whatever works. Not having the Dexcom information makes me twitchy, so I'll tar and feather myself if that's what it takes to keep this thing stuck on and keep my safety net intact. 

[Dexcom disclosure]  

September 10, 2012

Acting Rashly.

I slapped on my first Dexcom sensor over five years ago, using the old Dexcom STS system that lasted three days and you had to wear the giant sticky shower patch over the sensor to keep it from becoming water-logged.  (And I had to walk uphill both ways to get to the endocrinologist's office, dagnabit.)  Since first wearing the system, I've been addicted to the information, and I feel like I had the best pregnancy I could pull of as a result of following the graph.

Over the years, I've had few issues with the Dexcom, but early on, I saw a handful of weird rashes.  Thankfully, for the last few years (since about 2009), I haven't had any Dexcom-related skin issues.  Which means I've been suited up as a CGM robot without issue for years.

So why am I, all of a sudden, busting out with strange, itchy red rashes right underneath the sensor?  Two weeks ago, I put a new sensor on and after about five days, it was starting to itch like mad.  The results it was giving were spot-on with my meter, and I'm always reluctant to pull a sensor out too early (because even though they're usually fine once they're in, I hate the process of putting a new sensor on - creeps me out).  But the itch was tremendous, so on day six, I pulled the sensor off and was greeted by a raised, red welt-looking patch of skin, previously hidden by the actual transmitter.  It looked like a weird chemical burn.  And it itchy like crazytown.

After two days of bathroom home remedies (neosporin and a Muppet Show bandaid - thanks for lending me the "Kermit Frog" one, Birdy), the welt calmed down and reduced to a small patch of scaly-looking skin.  Now, almost a week later, it's just about completely healed and looks like it's about to peel, like a sunburnt spot. 

But the same day I pulled the old sensor, I put a new one on.  And damned if that thing didn't start to itch a few days later, too.  I only made it three days into that one (because I didn't want to encourage a weeping skin rash), and sure enough, a fledgling patch of itch was brewing up underneath that site, too.  The sensor I put on three days ago is on my left thigh and currently tingling, which makes me worry that I'm headed for a hat trick of itchiness. 

I knew I'd heard of this kind of reaction to sensors, pump sites, etc, so I searched online for some PWDs who had encountered itchy Dexcom sensors, and it became clear I wasn't blazing (scratching?) a new path.  Whole forum discussions were available on TuDiabetes and Children With Diabetes, detailing what is becoming unfortunately familiar to me. And Lorraine at This is Caleb has documented this skin irritation issue in a way that had me nodding in agreement and then itching in commiseration with Caleb.

The only time a flatline is quality.

Having used a CGM for over five years, I really value the information it gives me.  ("Value" also equals "am addicted to," because even in the weeks when I'm a little sloppier about my diabetes management, I'm still extremely grateful when the Dexcom wakes me up from a hypo in the middle of the night.  I can't properly describe what that kind of safety net means to me.)  So I'm not willing to give up my CGM, not even for a few days.  (In the last three years, I've taken it off so rarely that I feel creepy without it on.)

So now, it's about figuring out how to keep from acting rashly.  I have an arsenal of skin prep and barrier tapes to try out, and I'm hoping there's a combination that keeps my skin safe and my Dexcom fired up.  In the meantime:  I scratch my head (and site) in confusion.

February 16, 2012

Dexcom, Revisited.

My Dexcom had a day or two of throwing triple question marks.  And then it spluttered.  And died, offering up the CGM-version of the "blue screen of death."  That error stayed stuck on the screen no matter what buttons I pressed or how often i swore under my breath.

After emailing the team at Dexcom and speaking with my representative there, I was waiting (sort of) patiently for the Dexcom to arrive.  I don't often go more than a few hours between sensors swaps, so being without the Dex for 48 hours felt creepy. 

And it was a long two days.  I didn't realize how integral the Dexcom routine was to my schedule before the thing busted.  Even though the receiver was dead, I still found myself bringing it everywhere.  I still brought the receiver to the gym with me.  I kept clicking on the screen and remembering "Oh, the error.  Shit."  And it still ended up on the bedside table, even though it wasn't technically working.  I also did that strange "take your pants off carefully to avoid scraping the Dexcom sensor from your thigh" thing, even though the sensor wasn't actually on.  (I felt like a diabetes mime.)

The most mental adjustment was the "before bed" routine.  Normally, I do the bedtime bit (wash face, brush teeth, put the horrible, old-lady Muro 128 in my eyeball thanks to the Bird talons) and then snuggle into bed.  But the very, very last thing I do before bed is test my blood sugar, and then check the Dexcom graph.  Mentally, I need (want?) that security of knowing where I'm at before I embark on eight (HA!) six hours of sleep.  Seeing a blood sugar snapshot on my meter is one thing ("Okay, I'm 143 mg/dL.") but seeing where that number came from and where it's going is another.  ("Okay, so the Dexcom says I was 212 mg/dL before but now I'm 143 mg/dL with double-down arrows, so I might grab a swig of juice before going to bed.")  

So when the new Dexcom system arrived yesterday morning, I couldn't wait to slap this Bad Larry on.  I felt like I was flying blind for a few days, and I wanted the new sensor queued up as soon as possible.  I was almost as excited to see that FedEx box as a certain BirdFace was:

Bird in the Box!

It's strange, what becomes part of the routine.  Strange to tote that little egg-shaped receiver around with me everywhere.  Strange to miss the sensor stuck to my body.  But on Sunday morning, when I woke up with a blood sugar of 42 mg/dL without any symptoms of the low, missing the CGM didn't seem strange at all. 

Reunited with the Bad Larry.  (Different from the Awesome Birthday Larry from a certain awesome editorial assistant.)  I'm happy to be back to the routine. 

[Dexcom disclosure]  

February 12, 2012

Snapshots: Dexcom Err Code: 16R0F2D93c.

Dexcom Err Code: 16R0F2D93c.

This is the Dexcom error code that cropped up just after breakfast this morning.  It won't reboot, it won't show my graphs, and it won't make eye contact.  I think it gave up.   I've emailed Dexcom and am hoping to hear back soon - already feeling oddly naked without my CGM.

November 15, 2011

My Dexcom Sleeps Nude.

During the day, my Dexcom wears clothes because it's a modest little machine:

Suited up in blue. 

But at night, it strips down nude and sleeps in a "hyperbaric chamber" ...

Dexcom under glass

... because the glass makes the high and low alarm vibrations easier to hear.  I just have to remember to make sure the glass doesn't have water in it before I go dropping the receiver in. 

This is real life with diabetes:  awkward, a bit strange, and always on the move.  :)

October 25, 2011

Yes? Dexcom? You have a question?

"Yes, Dexcom?  You have a question?"

BEEEEEEEEEP!

"Oh, I see you have several questions.  Three, in fact.  Well let's just hold each other close and see if that helps, okay?"

BEEEEEEEEEP!  SENSOR FAILED

"Oh dear.  That's not good.  Okay, since we just stuck this one in, let's try it again, okay?"  Clicks a few buttons to restart sensor.  Sighs.  "Yes, Dexcom?  You have three questions again?"

WHAT ARE YOUR FREAKING QUESTIONS?  AHHHHHHHH!

I hate, hate, hate when Dexcom sensors don't queue up.  I don't often have this problem, but when I do, it makes me go completely and utterly berserk.  Putting a new sensor in doesn't hurt, usually, but it's not the highlight of my week, so having to peel off a sensor that's only a few hours old and stick myself with a new one makes my head explode with frustration.

(Am I the only one who pictures the Dexcom sensors questions as a long, drawn-out game of Marco Polo?  Where the receiver is hollering out "MARCO!" in the form of those infuriating question marks, never answered with a "POLO!" of any kind?  Maybe the sensor gives up because it's lonely.)

I gave this one a lot of tries (as you can see from the photo), but sometimes you have to tell technology to go screw and start over. 

[Dexcom disclosure

October 04, 2011

New Dexcom Goals.

Before getting pregnant, I lowered my blood sugar range goals on the Dexcom because I wanted my standard deviation tightened up ... and also because I know that for me, beating back those high blood sugars is my biggest challenge. 

Even though we are not moving towards another pregnancy (hell to the no), I still want to regain the kind of preconception control.  For the last few months, I had my Dexcom goals set between 200 mg/dL and 60 mg/dL, and I recently lowered my high threshold to 180 mg/dL.  Not a big change, but enough of one to make me pay closer attention and to put in that extra effort.

Trying my best to hit the mark.  Or stay between the lines.  Whatever the right catch phrase is:  that.

This isn't a no-hitter, but it's close.  I'm not aiming for perfection, but just to feel a little bit better.  That still counts for something, right?

September 08, 2011

New Dexcom iPad and iPhone App.

I'm not hooked on Apple products (I refuse to get an iPhone because I'm addicted to my Blackberry), but Chris and I do love that foolish iPad.  And I love seeing apps for diabetes devices stocking the virtual shelves in the iTunes store. Makes me feel like we're busting in to the mainstream, as a community.

Which is why I'm excited to see the first app from Dexcom.  (And it's free ... as these apps should be, in my opinion.)  While I'm hopeful that future apps include a way for the Dexcom receiver to transfer data to Mac products (because running parallels on my Mac is wicked annoying), this is a great start for people who are looking for introductory information on the Dexcom system.

One of the iPad screenshots - more here.


One of the iPhone screenshots - more here.

As a seasoned Dexcom user, much of this app includes repetitive information, but there is an FAQ section with answers to questions like "What is the Maximum Distance at Which the Receiver and the Transmitter Communicate" and "What does Error 0 Mean?"  This is information that applies to both newbies and veterans of Dexcom'ing.

The app is available now, and you can click on this link to download it yourself.  A Droid version is coming soon.

[Dexcom disclosure

September 07, 2011

Batting Practice.

If this lovely thing is a "no-hitter,"

:: sound of angels singing and kittens being petted ::

Then this shit day is batting practice:

:: that BEEEP BEEEP sound the alarm clock makes ::

Today, I'm hoping diabetes doesn't bat through the order every inning.

/baseball diabetes analogies

August 24, 2011

From Abby: Dexy Pictures.

Abby's been rocking the Dexcom for the last three months, and she's fully immersed in both the data mining and the photographing of said data mining.  Here's her "PWD photojournalist" take on Dexcom'ing and documenting. (Also, welcome back, Abby!  We missed you while you were at camp!)
*   *   *

I’ve had my Dexcom for almost three months now. While most of the time I hardly pay attention to it, sometimes I like to make a big deal out of certain graphs. I also had a habit of showing the really good and really bad graphs to people at camp this summer, and sometimes they took pictures of them. (Diabetes camp is a special kind of place, where we celebrate Dexcom graphs … it’s awesome.)

Anywho, here are a few of my favorites:


This was the closest I’ve come to a no-hitter and needed to show EVERYONE at a Tuesday dance at Camp Joslin. Normal. (Please ignore the gross shininess of my camp self.)


Then there was the time we went hiking and the combination of a 15g protein bar and a 75% temp basal kept me at a wonderful 140-150 mg/dL range the entire time.


I call this one "Dyslexy-Dexy," when I put a new Dexy sensor in and it was entirely confused about everything. My meter showed 117 mg/dL when this picture was taken.


This one is epic. I corrected after totally bombing a guess on pizza and ice cream (it was the day after I left camp, leave me alone) and then my correction factor worked BEAUTIFULLY overnight. Take that, beta cells. I don’t need you at all (unless you want to work again in which case I take it back and I totally need you).


This one is my absolute favorite. We got a cake at camp when all the nurses had passed their boards (I was the last one to take the exam, of course) and my bg was holding steadily under 100 from the time the cake arrived to the time we could eat it. I had to document this, obviously.

Sometimes diabetes plays fair. Sometimes it doesn’t. I like to keep these pictures to remind myself that no matter what I do, this stupid disease has a life of its own.  I’m also convinced it decides when it wants to play along and when it needs more attention, but that's a rant for another day.
*   *   *

All this talk about photos is making me feel veeeeery guilty about not keeping my Diabetes 365 feed up to date.  I need to get on that. :)  Are you a diabetes paparazzier?  Do you like to keep visual tabs on your diabetes bits and pieces?

June 09, 2011

Need vs. Want.

When I was planning my pregnancy, I wanted a Dexcom because I desperately wanted to bring down my A1C without crashing and burning into a pile of low blood sugars.  But when I was pregnant and dealing with the epic lows of my first trimester (hello, 29 mg/dl without symptoms), I needed my CGM.

Sometimes the Dexcom is not on-target.  If I am hyper-calibrating and feeding it too much information, I run into false-highs when I exercise and numbers that range a little more elevated than they actually are.  (That's running on the assumption that my meter is accurate all the time, which I know it's not.  And I take serious issue with that, but that topic is for another blog post.  A really long blog post with expletives, I think.)  Other times, the Dex is off for no reason at all.  But the number of ??? I see on my receiver are (thankfully) very, very rare, and I also don't experience a lot of sensor errors.  

When it's wrong, I get all huffy and pissed and I rant to my social media friends (aka the poor souls who are forced to Tweet alongside me), but it's always easier to complain about the bad stuff.  Who spends time talking about how wonderful their technology other is?  Nah, much easier to just gripe when they're being doofuses.  (Spellcheck doesn't like that word.  Doofusi? Doofusees?)   

But the other day, our stereo system went off at 5 am for absolutely no reason, pumping the sound of Aqualung into every speaker in the house.  Thus waking me up.  And Chris.  And the baby.  (Remember - this is at 5 am.  Fun!)  And of course BSparl wanted to stay up and play once she saw her mommy stumbling in with crazy bedhead.  So when her nap time rolled around, I decided to take one, too.  Chris was out working, so the house was peaceful and quiet.

And it wasn't until I woke up, groggily, to the sound of Birdy calling for "Mama!!!" into the baby monitor that I realized I was low.  But I didn't feel super low, just sort of crabby.  I figured I was in the 60's, but a quick finger prick proved me very wrong.  Meter showed 37 mg/dl.  I grabbed a fistful of glucose tabs from the jar on the bedside table and chomped them down, thinking absently about needing to weed the garden and thankful that the baby was playing instead of crying. 

Oh, and where the eff were my low blood sugar symptoms??

The Dexcom receiver and transmitter were sitting on my bathroom counter, waiting patiently for me to put a new sensor in, since the old one had peeled off that morning.

It would have woken me up when I was 60 mg/dl, instead of me waiting for the 30's.  It would have alerted me well in advance.  When it shows me double-arrows pointing up after what I thought was a reasonably low-carb snack and lets me catch a high-in-training, I am thankful for the Dexcom.  And when it beeps in the middle of the night to let me know I'm out of range, gives me the opportunity to correct it, and allows me to sleep in blissful blood sugar HappyZone, I am thankful. 

When I spoke with the Joslin medalists, they all mentioned hypoglycemic events.  And how scary they were.  They feared the lows more than the highs, because of the immediacy.  You can live for years with highs, but you can be stolen instantly by a low.  A few of the medalists were wearing CGMs.  And they all mentioned how amazing the technology, regardless of the brand, has become.

I thought about the 37 mg/dl I had while I was asleep.  

And in those moments, I realize I need my CGM. 

I love this picture. I want to tattoo it on my pancreas.

[Dexcom disclosure]

February 10, 2011

From Abby: Standards of Care.

Note From Kerri:  Lows suck.  Larry Bird blood sugars shouldn't be making appearances in the wee hours of the morning.  And not waking up right away for these kinds of lows can be terrifying.  Abby (the Person) writes about a low that left her reeling and the superhuman strength of her wonderful mom.

*   *   *

8:00pm – 276 mg/dL (no idea why)

10:30pm – 288 mg/dL (negative ketones, and the correction bolus that ruined everything - give me a minute to explain)

12:00am – 120 mg/dL (3/4 bolus for a snack, and to bed I went)

1:45am – 33mg/dL (awesome)

I know why this happened. When I took that second correction at 10:30 pm, I thought to myself, “I might go low from this, but I feel like crud, and I’ll just eat a snack before I go to bed.” And so I did: a very small bowl of Raisin Bran cereal, only bolusing for 3/4 of it, and off to bed I went with a blood sugar of 120 mg/dL, feeling like I avoided that low.

Feeling pretty dia-successful.

When I woke up at 1:45 am feeling a little warmer than usual, but with no other symptoms, I decided I should probably check. Moms are badass and can lift like a million times their own weight. Ants are cool, too.

33mg/dL. (Editor's note:  Whoa, Larry Bird) 

Defeated. You win tonight, diabetes. A 6oz juice and a 19g granola bar later, I lay back in bed. And that’s when things got scary: seeing stars, extreme sweating, nausea, crying (which is new to me, and frankly I’m not a fan). I grabbed the glucose tab bottle, and obviously it was brand new and had that cannot-open-without-a-chain-saw plastic thing under the lid.

By this point I was freaking out. I stumbled into my mom's room (yes, I’m 23 and I live with my mom; times are tough, people and I’m a full time college student with two jobs, don’t judge me) where she saw the tears and the shaking hands and presumably my face sans any sort of color. She grabbed the bottle and ripped the plastic off with that “my daughter is in danger” sort of strength that I still don’t understand. All I could manage to eat were three glucose tabs.

I really thought I was going to die, like straight up fall on the floor (only with a blood sugar probably in a safe range at this point) and just die. The re-check showed me a 66mg/dL. Then I got really frustrated because I was almost back in range but I had EVERY low blood sugar symptom on the face of the earth, only on steroids. (For some reason updating my Facebook status and texting a few friends at this point seemed like a grand idea.) This is not the first time I haven’t woken up until I was under 40mg/dL. I’m sure it won’t be the last, thanks to my lack of a continuous glucose monitor. Actually, I take that back … I have a CGM, but I hate it. I try it at least once a month, I do everything by the books, and if I get one or two readings that are within 20 points of my finger stick, it’s a miracle. I’ll be starting a 7-day-trial of the Dexcom soon, and I already have an email into my endocrinologist asking her for one of my own.

The point of my story is to ask this question:  Why aren’t CGMs a standard of care for diabetes? I bet if I asked my friends who have diabetes for similar stories, I’d get a boatful.  (Then I would send that full boat to insurance companies and ask them if they’d rather dish out a few hundred dollars every month for their patients to have sensors and stay safe, or keep refusing us, keep making it a huge hassle to achieve safety, and instead keep sending me 87 million boxes of test strips that expire before I even think about opening them.) 

The technology is here, but there is clearly nobody working for those insurance companies that knows the first thing about the fear I’ll have when trying to fall asleep tonight.

*   *   *

What makes me nuts is that people who want and need a continuous glucose monitoring system still can't find coverage through their insurance companies.  We've come such a long way, technologically-speaking, and it's frustrating when a fellow PWD can't readily access that technology.  What insurance battles are you fighting?

February 09, 2011

A CGM Visual.

When I look at the graph on my Dexcom, I like to see a nice, flat line.  You know, like a bread stick (that would be flat if I had rotated it a bit in Photoshop but I forgot and now it looks a little like it's a rising blood sugar holy run on sentence AGAIN #Bes).  Imagine it flat:

A breadstick.  Not to be confused with "Breadsticks," which is from Glee.  And Glee is awesome.

But some days, my Dexcom graph looks a little less friendly, and more like a big ol' mess.  Like a rollercoaster:

I can't even look at roller coasters without thinking "Oh!  Diabetes!"

Or the top of the Arby's hat (that's on days when my blood sugars really kick my ass):
Arby's burgers gross me out.

Or that picture from The Little Prince where a snake devours an elephant and it looks like a hat:
One of my favorite books.  Kid had his own planet!

And there are some days when the stupid thing looks exactly like a giant letter M, having tea with a giant letter W:

Oh cut me some slack.  I suck at Photoshop.  But that M and that W do look delightfully happy, no?

I aim for no-hitters as often as I can, but it seems like tea parties are all the rage these days.  I need more breadsticks.  

(And now I'm seeing CGM graphs everywhere I look, and it's freaking me out.)

January 20, 2011

What Dexcom Shows Me.

I'm very rarely caught without my Dexcom, and I've been wearing a sensor for the better part of the last three years.  But wearing a sensor doesn't mean that every low is caught and every high is avoided.  What it does mean is that I see every high and low in a big picture format, leaving me sometimes with more information than I know how to process.  So when I finally (FINALLY) have a no-hitter, I want to share it.  Because damn it, I was proud to have 'colored within the lines' for a full 24 hours … it's been a long time since I've been able to say that.  And it's also been a long time since I've cared to try.


The Dexcom graphs don't always look like this, though.  I have more days than I'd like to admit where the graph looks like a giant letter M.  Or a W.  Or an M and a W with an ampersand or some other mess in between.  I don't have a lot of pictures of the crap graphs because they don't inspire my inner photographer.  ;) Instead, they inspire me to hide the receiver in the bottom of my purse and not look at it for a few hours.  But I like the no-hitters.  I want to dress them in sassy hats and do Glamour Shots with them.  And I want to post them because I feel like there are a lot of "OMG I can't do this" posts on here, and it feels good to say that I had a good day, you know?

Last night on the weekly #dsma (Diabetes Social Media Advocacy) chats on Twitter, the question asked was "Do you believe the A1C results you see posted online?"  Last night, I said that I am not sure, but after thinking about it for a bit, I do believe the results posted online.  Almost exclusively.  That's part of what makes this community so notable and so impactive.  This diabetes online community isn't known for its jabbing remarks and cruel behavior.  We treat one another as extended family, and respect for those who are struggling is just as high for those who are succeeding.

And I love that.  I love that I've found support and camaraderie in both my well-managed numbers throughout pregnancy and in my recent crummy A1C/burnout cycle.  I need that, as a person with diabetes, because it's the emotional support that helps lift me out of a funk, and also helps me maintain a strong streak.

So yeah.  A no-hitter.  And the power and honesty of the diabetes online community.  I'm celebrating both. 

December 14, 2010

Larry Bird, No One Invited You.

My symptoms of low blood sugar used to run the gamut:  numb mouth, dizziness, sweating, crying at will, shakiness, inability to see completely clearly but a heightened sense of hearing ... fun stuff.  The symptoms of a low blood sugar can really suck.

But you know what sucks even more?  Not having any symptoms at all.

A few days ago, I was making lunch for BSparl and trying to clean up the kitchen (never a good idea at the same time), and my hands felt a little fluttery.  But nothing really worth paying attention to for more than a second.  BSparl devoured her rice cereal and mushed up bananas and then she was down for her nap. 

As I closed her bedroom door, I heard the Dexcom BEEEEEEP!ing from the kitchen counter.  There's a different sound associated with the "low" and "high" alarm, and I was surprised to hear the low alarm sounding.

"I feel fine."  I said, matter-of-factly, but not sure I meant it.  I did feel just slightly ... off.  Abby (the cat) meowed as she circled around my ankles.  But a swipe with my blood sugar meter showed me at 33 mg/dl.

Oh come on, Larry. I love you, man, but not like this.  Not as a blood sugar.  

The problem was that I didn't feel low.  At all.  I didn't have even a whisper of a hint from my body that my blood sugar was rapidly heading towards chaos.  If it hadn't been for the Dexcom, I'm not sure I would have tested.

Instead, I found myself standing in front of the fridge and sucking down grape juice straight from the bottle.  (Note:  Don't drink the juice at my house.  I've licked all the bottles.)  Auto-pilot kicked in and I treated that 33 mg/dl as though I could feel every bit of it.

Oddly, I didn't start to feel low for another five minutes or so, when my blood sugar started to come up a bit.  Such a strange thing, but when I'm coming up from a Larry low (read:  in the 30's), it doesn't throttle me until my blood sugar starts the journey back upwards.  Around the 50 mg/dl mark, I started to hit the sweats, the adrenaline panic, and that weird, white fog of precision that envelopes me when I'm low. 

This lack of symptoms has me very nervous lately.  I know that my numbers have been both pinging and ponging all over creation lately, but it's downright creepy when I'm at a blood sugar so close to chaos and I feel like I could happily climb into my car and start driving, or pick up my daughter and start dancing, or wait just a little while longer before deciding to have a snack.  My body doesn't give me the hints I need anymore, and I'm not sure why. 

Diabetes is messing with my head.

My paranoid (and hyper-sensitive) Dexcom continues to wail even after I'm back up to 70 mg/dl, but I find the noise comforting.  I know I'm back in range, and I don't have that feeling of confusion or fogginess.   

"I feel fine," I said again, only this time I meant it.  

I wish every day could look like this.  But it, um, does not.  Lots of times, I see a big letter M.

October 28, 2010

The Day the Dexcom Died.

It's weird, because even though I spent almost 21 years without the assistance of a continuous glucose monitor, I'm hooked on the thing now.  It's a second device, it's another site stuck to my body, and yet I'm happier with the extra hardware than I am without it.  

Because, to be honest, testing as frequently as I had been in the past is a little trickier with that baby bird rolling all over the house.  I'm back up to about nine times a day, but that's a far cry from the 15 times I was rocking out with during pregnancy.  (And for me, as a type 1 diabetic with blood sugars that go berserk due to the influence of emotions, not just food, testing is a saving grace for me.) 

So I feel much more prepared with the Dexcom filling in the gaps between actual finger pricks.

Which is why, when I saw this error message on Monday, I bugged out a little bit a lot:

Dexcom error message ... surrounded by BSparl's panda toys.

I was in the shower at the time, with BSparl in her little bouncy seat on the bathroom floor, and we were chatting about soap and bubbles and how Abby the Cat is far too fat to climb trees, when the Dexcom let out a little BEEEEEEEEEP from the bathroom counter. 

"Whoa, settle down there,"  I said to the receiver.

BEEEP!  (It was a shorter, sadder one this time.  I was concerned, because I'd never heard that noise from the Dex before.)

"You okay?"  I asked the inanimate object.

BEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEP!  

it was like that moment in Braveheart when William Wallace is being tortured at the very end, ripped open and crying out for "Freedom!!!!"  The Dexcom let out that last, extended wail and then threw out the error message. 

"Oh damnit, I think it's dead now," I said outloud.

"Mmmmm mmmmmm!"  said BSparl, waving her little arms excitedly.

And when I examined the receiver and saw the big, fat exclamation point o' death, I knew the receiver was toast.  So I sent a spastic email to my friends at Dexcom and they overnighted a new receiver.  And as soon as FedEx arrived, I slapped on a new sensor and felt better.

It's strange how I have a hard time imaging my diabetes management without things like Humalog (I was diagnosed in the era of cow and pork NPH and Regular), insulin pumps, continuous glucose monitors, and meters that don't take 120 seconds to give you a result.  This CGM is a far cry from the Clinitest tubes of my diagnosis. 

"Back in action, kiddo."  I said to BSparl, throwing the Dexcom egg into my purse as we prepared to go for a stroll.

"Yaaaaaaaaaa!!!!"  She laughed, and threw her hands in the air, and burped loudly. 

(You stay classy, BSparl.)

[Dexcom disclosure

October 06, 2010

Appreciating the Dexcom.

After BSparl was born, I was overwhelmed with adjusting to life as a mom, and diabetes took a backseat to just about everything.  I was healing from my c-section, attempting to snap up all the snappy things on BSparl's clothes, and figuring out how all the pieces were coming back together after having been completely blown apart.

I experienced some extreme diabetes burnout, where I stopped exercising, cut way back on testing my blood sugar, and the Dexcom receiver collected dust in my bathroom cabinet.  

But I've been really trying to get my act together here.  Now that we're quasi-settled in our new house, I'm back at the gym, testing with an increased frequency, and tuning back into my diabetes management.  I couldn't force these issues, though.  I needed to get things rolling again once I was really ready, and not beforehand.  With BSparl a little older (almost six months old!) and her schedule actually resembling something plot-table, I knew it was an okay time to start focusing on myself a little more.

I'm resolved to make exercise part of the equation once again, and I'm doing well with that goal.  And to be filed under "TMI," I'm keeping my glucose meter on the bathroom counter and am testing after every visit.  (Sounds weird, but it helps me remember to test and helps shrink the gap between blood sugar checks.)  And I'm back to Dexcom'ing it 24/7.  

I didn't realize how much I missed this thing until I took a few weeks off.  

Dexcom warrior rides again!

It's easy for me to slack off when I'm avoiding my glucose meter.  Mostly because my glucose meter doesn't scream at me every few hours.  But the Dexcom does.  Once it's on and calibrated, it BEEEEEEEEEP!s every time I'm high, low, or if it needs a blood sugar number.  I am the puppy to its Pavlov, and having this sensor stuck to my body doesn't feel as cumbersome as it did when my stomach was swollen with BSparl and then recovering from birth.  I feel ready for this information again, instead of overwhelmed by it, and I'm ready to make use of this data.

In the last two weeks, my meter average has come down from 179 mg/dl (ouch) to 148 mg/dl.  And I'm hoping that I can bring it down a little more in the next two weeks, hopefully while avoiding the extremes on either end of the spectrum. 

While I know plenty of people with diabetes wrangle in their numbers without the use of a CGM, I seem to be better off with one.  Something about that constant stream of information keeps me both accountable and tuned in.  Even though I'm not a fan of wearing a second device (hello, skin real estate issues), my health is better for it.  Sometimes it takes coming back from a round of diabetes burnout to remind me why I fought so hard for this device in the first place.

[Dexcom disclosure]

July 21, 2010

Trends.

So here's a trend:  Today, I woke up to the sound of my baby cooing from her bassinet.  My hands reached over to the Dexcom receiver and I clicked on the button to light up the screen.  I saw a "74" and an arrow trending oh-so-slightly down.  So while Chris changed the baby, I went out to the kitchen to grab a swig of juice before settling in to breastfeed BSparl.  I fed her and then went into the living room to play with her.

Notice any problems here?  Anything ... oh, I don't know ... missing?  Like maybe a blood sugar check when I woke up?  Or at least one after I fed her?

Nope.  Nothing.  No test.  I went all the way from waking up to freaking NOON before busting out my meter.  This is a terrible trend.  And it's happened twice in the last four days.  I'm relying way too much on my Dexcom for guidance, instead of double-checking every hour or two with my meter.  I mean, missing a fasting blood sugar?  I've never, ever done that before.  Even in college, when I was at my diabetes worst, I still tested first thing every morning.

This is not a trend I want sticking.

I miss these little blue guys.  :)Here's another trend:  For the most part, I am BSparl's daytime friend.  During the day, Chris leaves our home office for a distraction and baby-free zone where he can focus on his writing.  So for several hours a day, BSparl is left to her mommy's devices.  (Including, but not limited to, visiting friends for lunch dates, running household errand-type things, and my own attempts to get work done.)   When I'm hanging with the baby, getting to the gym is impossible, and with the weather so hot and humid lately, I don't feel comfortable taking her for a walk in the stroller.  By the time Chris gets home, and we talk for a while, and we have dinner, etc. etc., it's suddenly so late that it's almost time for Colbert to come on.  (NATION!)  And I'm too exhausted to hit the gym.

This is not a trend I want sticking, either.  

A lot of the baby weight has come off (thank you, breastfeeding), but I am in desperate need of some muscle toning.  I need to get some workouts in as part of my schedule in a hurry, because I'm growing tired of feeling flumpy.  Before I got pregnant, I felt good about my body.  Now?  I need a little more effort to get back to fighting shape, or at least faux-fighting shape.  (Like the kind of fighting that includes throwing styrafoam peanuts.  Or something similar.)

The trends of missing blood sugar checks and workouts must end TODAY.  These habits are too damn crappy to let them continue.  I can't let these two trends wreck my goal of good health.  Small changes can make the biggest difference, so as of this moment, I'm realigned myself to test every morning and to get some exercise in at least four days a week.  (I was doing five days a week for years, so four days isn't a bad starting point.)  And it doesn't have to be a gym workout - I'll take anything from a long walk with the stroller and BSparl to an ellipmachine workout to a bike ride. 

Why am I rambling on about this?  Accountability, my friends.  By telling you, I'm setting myself up to be accountable for my actions (or lack of action).  It worked in helping me get my diabetes reigned in for pregnancy, and I hope accountability can help me get my act together to be a healthier mom.

May 26, 2010

Oxygen Mask.

Gotta wear mine before I can help BSparl.In the airplane safety manuals, they instruct you to, in the case of an emergency, put your oxygen mask on first, before assisting others with theirs.  Makes sense.  Can't help someone if you are in need of help, yourself.

Chris and I reference the "oxygen mask" all the time, mostly when I'm low.  During the course of the pregnancy, I had some wicked lows that kept me from attending conference calls, making it to dinner meetings, and even just meeting a friend out for coffee.  "I'm going to be late, but I need a few minutes.  Oxygen mask, you know?"  And Chris would nod, knowing that I was waiting until my blood sugar was stable before I headed out. 

But as I wrote about yesterday, I'm in the middle of The Suck.  Can't wrap my head around what I need to do in order to take care of myself, because I'm too overwhelmed with what my daughter needs.  The baby learning curve is pretty steep, and both Chris and I being schooled on just a few hours of sleep.  My baby is well-cared for, but my diabetes management has seen better days.

... so I guess my baby isn't as well-cared for as she could be.  Because I'm trying to put her oxygen mask on while fumbling with my own.  

Yesterday's post had some good ideas in the comments section, and I'm going to try and implement them going forward.  Like the testing suggestion.  I'm already testing my blood sugar before I feed the baby, so now I need to find other benchmarks in my day to assign testing to.  I'm working off a mental "even numbers" schedule today, making sure that I test at all the even hours.  I'm awake around 6:15 am every morning, so that means I get a 6 am fasting, and then a test every two hours. 

Some other things I simply need to make part of the routine.  So it becomes natural(ish).  Like the Dexcom.  That tool is extremely useful to me ... when I look at it.  For the last 11 days, I had a sensor in and the Dexcom was working great, but I wasn't looking at it.  The receiver would sit on the dining room table while I worked on my laptop and I'd barely pay it any mind.  Then, one night when it was pinging because I was high, I turned off the high alarm so that it wouldn't wake up BSparl.  Being the dingbat that I am, I left the high alarm off.  For four days. WTF?  What's the point of wearing the device when I'm not using it when I need it most?  Today, a new sensor goes on and I'm determined to reset the alarms and to actually use the data.  (Otherwise, what's the point?)

And then there's what Chris and I call "life stuff." Like remembering to call in my reorder for insulin to my mail order pharmacy.  And then remembering to pick it up from the mail drop.  Or remembering to throw a bottle of glucose tabs in my purse or the baby bag, or grabbing a back-up insulin pen, or making sure I have enough test strips in my meter case to get through the day.  Maintenance.  Life stuff. 

But I can't do all this stuff at once.  Baby steps, right?  Today, I'll start with testing more frequently and rearming myself with the Dexcom.  I threw a bottle of glucose tabs both into my purse and the baby bag this morning, and I called in my insulin reorder a few minutes ago.  New bottle of test strips is floating around in my purse.  Small changes that will hopefully make a big difference in how things roll out, diabetes-wise.  Because the better care I'm taking of myself, the better care I'm taking of the little BSparl baby.

Oxygen mask, you know?

May 25, 2010

The Suck.

Bright?  Not me these days.While motherhood is going well and I'm completely in love with my daughter, I'm reminded, daily, that diabetes doesn't care if I've slept or if I have carefully counted carbs or if I've just changed my infusion set.  Diabetes doesn't give a shit about my schedule.

It's The Suck.

Like last week, when at 4:30 am, my "alarm" went off - also known as BSparl starting to fuss and wail from her bassinet in our bedroom.  Not a problem.  I woke up, tested my blood sugar, and saw that I was 176 mg/dl.  That number (albeit spiky) works just fine for feedings, so BSparl and I spent some quality time hanging out, having an early snack, and debating where exactly the sun hides behind the trees before it starts to poke out.

We both went back to bed around 5:45 and slept until the next alarm went off - the Dexcom BEEEEEEEP!ing wildly at me at 8 am.

"Do not wake up the baby, you."  I grumbled while fumbling for the receiver on the bedside table.  "LOW.  Under 55 mg/dl" was the warning it was flashing up at me.  While BEEEEEEEPing.

"Shhhhhh!!"  I unzipped my meter case and deftly stuck a strip into the top of the machine.  I wasn't sweaty, my brain was functioning fine (aside from shushing inanimate objects), and I felt physical capable.  Maybe the Dexcom was just being finicky and throwing lower numbers?

"36 mg/dl"

Well shoot.  Not a whisper of a symptom, either.  I got up from the bed and wandered out to the kitchen, where Chris was making his protein shake.

"Can you keep an ear on the baby?  I'm 36 and just want to grab some juice," I said, opening the fridge door.

"Of course."  Pause.  "What?  You're 36??"

"Yeah.  No symptoms, dude.  Not even one."  I chugged a few sips of grape juice and put the bottle back in the fridge.  "I feel fine.  The Dexcom woke me up."

A blood sugar of 36 mg/dl without a single symptom, other than a wailing Dexcom and a bit of a groggy feeling.  But, in true diabetes form, once my blood sugar started to rise, I felt the symptoms acutely. 

"I feel pretty bad right now."  Shunk.  "Fifty-six.  Why do I feel worse at 56 than I did at 36?"

There's no rhyme or reason to diabetes.  The symptoms of lows and highs change with the seasons, it seems.  And they come without warning, these numbers.  Sometimes it's a hormonal or emotional surge that sends numbers pinging.  Other times, it's a little, teeny technical glitch that sends thing spinning.

Like two nights ago, when I bolused for a snack and felt a damp spot on the side of my shirt.

"What the ..." and I probed with my fingers and felt that telltale wetness around the gauze of my infusion set.  I tugged up the side of my shirt and gave the spot a sniff - yup, that bandaid smell.  Frigging infusion set was leaking some how.  No symptoms, though.  I wasn't thirsty, I wasn't lethargic, and I was actually just about to head off to the gym.  I felt pretty okay.  Problem was, I hadn't tested in about four hours, nor had I peeked at the Dexcom.  So basically, I didn't have a clue what was going on in my body. 

I tested my blood sugar and a 423 mg/dl grinned back at me.   

(Have I mentioned Yosemite Sam yet in this post?  Suffice to say, I rocketed through a list of curse words that would have caused Yosemite Sam to give me a frick-a-frakin' high five.)

New site, quick injection with an orange capped syringe from the fridge, a ketone test (negative), and an hour and a half later, I was down to 195 mg/dl.   But I was pissed.  Because during the course of my pregnancy, I maintained an A1C between 6.0% and 6.5% and I busted my butt to keep myself controlled.  But now, with my body reacting to adjusting levels of hormones and a serious lack of concentration due to a truncated sleep schedule (read:  no sleep 'til Brooklyn, with Brooklyn being college, I think), I'm all over the map. 

I'm frustrated with my control, or lack thereof.  Trying to figure out my post-pregnancy insulin needs and taking care of my little girl have become a full-time endeavor, and I'm not getting it completely done on either front.  I have to buckle down.  These epic lows and highs are not fun, and are wrecking havoc on my healing body. 

Next week, I'm back at Joslin to see my endo.  Diabetes needs to take center stage until I can get things under better control.  It's my priority.  I need to get back to logging, to testing every hour and a half or so during the day, to actually cooking meals instead of just snacking when time allows, to changing my infusion set when it's due, not when it's convenient. 

... after diaper changes, of course.  And breastfeeding.  And BSparl laundry.  And pediatrician appointments.  And 3 am feedings.  And that occasional moment when I lock the bathroom door and look at myself in the mirror with determination and say, "Get it together, Mommy."  

May 10, 2010

A Day in the Life of a New Mom with Diabetes.

For D-Blog Week, Karen challenged the diabetes blogging community with a week's worth of blog prompts. Today is "A Day on the Life," and I've decided to focus on my new life with BSparl.  (Because if I tried to pretend that motherhood isn't affecting my diabetes, I'd be lying my face off.)

DING!!!  Game on.

A day in the life of a mom with diabetes5 am:  Alarms?  We don't need no stinkin' alarms.  Because now we have little baby girl who wakes us up at all hours of the night. 

When BSparl starts to fuss from her bassinet, either Chris or I leans up to check on her to make sure she's okay.  Since Chris usually does the 1 am feeding with a bottle, I try and do the 5 am feeding.  Since I'm breastfeeding, what I need to do first is check my blood sugar.  Anything less than 120 mg/dl and I'm snacking while she's eating.  I start this feeding at 98 mg/dl.

5:15 am:  BSparl is done with one side.  I switch her to the other side to finish eating, and I brush the foil wrapper that the fruit snacks came in to the floor.  

5:45 am:  BSparl is fed, burped, changed, and tucked back in.  I test my blood sugar again - now I'm 74 mg/dl and the Dexcom is showing a bit of a drop.  I wander out to the kitchen for peanut butter and a piece of toast.  (Not froast.) 

7 am:  Up again, only this time because the Dexcom is blaring at me.  49 mg/dl.  WTF?  Breastfeeding has very unpredictable effects on my blood sugars.  Some mornings, it doesn't make me low at all.  And then other mornings, it makes me plummet.

7:30 am:  BSparl and Chris are asleep in the bedroom, so I settle in on the couch with my laptop and a cup of tea.  My goal?  Answer some emails, write a blog post, finish some stuff that always seems to be due and I'm chasing the deadlines of, and use the breast pump to stash some milk for BSparl.  My insulin pump tubing sometimes gets tangled up in the breast pump tubing.  Which makes me think I'm wearing too many freaking pumps.

9 am:  Husband and daughter emerge, both sporting the same furrowed brow of the morning.  BSparl needs to be fed again, so I test my blood sugar to see where I'm at.  145 mg/dl - thank goodness.  Enough with the lows.  Bring on the BSparl!

11 am:  All of a sudden, it's almost noon, and I haven't eaten anything since 7 am.  I also haven't answered a single email.  Or finished the article I needed to finish.  My mornings are usually spent testing my blood sugar, feeding BSparl, changing her diapers (which have baby Sesame Street characters on them, which makes me laugh.  Because what do you call "Baby Big Bird?"  Little Bird?), and doing laundry.  I test my blood sugar - 118 mg/dl - and thank God that it's not pinging all over the damn place today.  Because some days it does. 

High Noon:  Still haven't eaten.  I force myself to stop and devour a Greek yogurt.  Blood sugars are holding steady.  But my pump site is aching a little - when was the last time I changed out the site?

Noon-thirty:  BSparl and I investigate the site.  Well, she hangs out in her bouncy chair on the bathroom floor while I take a look at the infusion set.  Looks fine - edges are peeling a bit - but it's only been four days.  Even though the reservoir isn't anywhere near empty, I opt to change the site because it's achy.  And because if I don't do it now, while I'm thinking about it, it will be another full day before I remember.  With all of my focus on BSparl and adjusting to life as her mommy, sometimes diabetes takes a wicked back seat.

1 pm:  New infusion set is in, baby girl is getting a bottle of breast milk because my own breasts need a break sometimes, and I still haven't answered one single email.  Is this why people take maternity leave?  I need some coffee.

2:15 pm:  Thirsty as all hell.  Test again - oh, that's nice.  233 mg/dl.  Frigging pump site change ... did I forget to take a little 0.3u bolus before pulling the site?  That seems to be the only way for me to avoid post-site change highs.  But of course, I had forgotten to do that.  And now I'm basking in the warm warming glow of a high blood sugar.  FanTAStic.  Still haven't eaten lunch, and now lunch is on a further delay due to the high.  I bolus down the high.

2:45 pm:  Dexcom shows that I'm dropping.  Meter confirms the same - 177 mg/dl.  Thing is, with the baby now out of me, I'm trying to figure out what my body's insulin needs are.  And that's tricky, because with breast feeding, I am never able to do an accurate basal test.  I have an appointment with Joslin in two weeks (for my 6 week follow up after surgery/birth), so I'm trying to log blood sugars to give my endo something to go on.

2:46 pm:  CRAP!  I haven't logged any blood sugars in three days!  With BSparl in my arms, I open up my laptop and try to find the spreadsheet.  I locate it, and then try to scroll through my meter memory and type the blood sugars into the spreadsheet using one hand.  BSparl decides this isn't a good time for her, and she makes a sound not unlike a can of shaving cream being deployed.  (She is a delicate, fragile, pooping flower, this child of mine.)  Diaper change time!

3:30 pm:  Lunch.  Finally.  Blood sugar is 109 mg/dl.  Lunch is a turkey and cheese sandwich, even though I'd much rather go low-carb these days to help lose the pregnancy weight.  But without carbs, I'm low all the time after feeding BSparl, so carbs it is. 

4 pm:  Time to head out to the grocery store and then to the post office.  BSparl hangs at the house with her dad while he works, and I test once more before getting into my car.  167 mg/dl.  How is the post-prandial that high?  I counted those stupid carbs.  My insuiln:carb ratio, I thought, was settled back into 1:12.  I need to test that ratio again, but no time today.  Must run errands.

4:04 pm:  As much as I love my daughter, I felt guilty blasting the Beastie Boys while she was inside of me.  Without her in the car, I can crank up the volume of the music again.  So i do.  As I head to the grocery store.  Damn, my life is a thrill a minute.

5 pm:  Walking out of the store, I realize that my Blackberry has been pinging for three hours and I haven't looked at it yet.  Checking the emails, I see that 75 emails have come in since 7 am.  And I STILL haven't answered a single one.  Whoops.

6:30 pm:  It's time for BSparl's dinner.  And then we read a book together - I like Dr. Seuss, but sometimes we read other books because I can only make my mouth navigate words like "Th'need" so many times before I start to either giggle or accidentally spit on my daughter while reading.  

7:45 pm:  Chris heads down to the gym and I prepare to go when he gets back.  (No, I'm not really "exercising."  Can't for another two weeks, due to the c-section.  But I can go for walks on the treadmill, so that's what I do.)  I test my blood sugar (139 mg/dl) and get all my crap together for the gym:  Dexcom receiver, meter, cell phone, reaction treaters, and that ever-elusive pair of workout pants that actually FIT. 

9 pm:  Back from the gym, blood sugars are steady for once, and BSparl is napping.  FINALLY, I answer some emails and finish up that article.  Oh crap - dinner!  I find something in the kitchen that doesn't require much assembly.

11 pm:  I realize that, since 5 pm, I've either fed BSparl or pumped six times.  How is that even possible?  Sure does account for the unpredictable blood sugars, though.  My body is in a constant state of "feed," making trends nothing short of chaotic.  And I have to be honest - I'm not sure I have the mental bandwidth to wrangle in diabetes and motherhood with any kind of precision these days.  Working off of very little sleep, and trying to understand the new swell of hormone changes in my body, is frustrating as hell.  Diabetes fine-tuning isn't my top priority these days.  I just want to coast as safely as I can at the moment.  (Note to people who may want to lecture me about my own health: Back off for a few weeks before you run cryptic commentary.)

Midnight:  What am I thinking, still awake??  BSparl will be up in two hours for her 2 am snack.  I'd better restock the bedside table with low blood sugar snacks and call it a day.  

Midnight-thirty:  Whoops, forgot to test.  94 mg/dl.  Dexcom confirms it's a steady number.  Off to bed!

Game Over ... until 5 am.  :)

February 25, 2010

Free Shower.

I love "free shower" - which, if you're diabetic and using an insulin pump or a CGM, you know that means "the shower when you're changing sites and you don't have any hubs connected to you."

It's nice to lather up and not worry about catching on an infusion set or a sensor edge.  Thing is, this is what's waiting for me when I'm done getting all cleaned up:

Oh I love me some free shower.
The potlock o' diabetes crap

Yesterday was "free shower" day for me, which is a rarity now that I'm wearing two devices.  The chances of an insulin pump change synching up with a Dexcom sensor change are pretty low, so when I'm swapping both, it's particularly nice.  And this scene on the bathroom counter is what needs to be reapplied after the fact.

That's the potluck of diabetes devices:  the Dexcom sensor, transmitter, and receiver, and then the insulin pump, infusion set, cartridge, and little bits associated with pump site changes (like that all-important insulin).   If you look fast, you can almost fool yourself into thinking it's a photo of make-up stuff, like any lady would have on her bathroom counter.  But the Sparlings don't have a "powder room," - we have a "site change room." 

I'm adjusting, though.  Don't we all?  Back when I first started pumping, I was freaked out about the whole "external symptom" because I'd existed 17 years without one.  Popping in those first infusion sets and clipping on the pump was a very surreal experience, and one that it took me some time to get used to.  ("Do I look like a robot?  Not really, but sort of.  Am I okay with looking a little like a robot?  Do I get special powers?  No?  That's only super heroes?  Okay, well what do robots get?  They're maids on the Jetsons?  WTF?"  The internal monologue was constant back in those days.)  Adding in the Dexcom sensor and receiver sent me back into that "Wait a minute ... I'm now like a SuperRobot!" mode. 

But now, it's been six years with a pump.  And almost two and a half years with the Dexcom.  So while free showers are nice and I like that feeling of not having anything attached, once I put on the new sensor and the fresh infusion set, I still felt fine.  The sites don't look so scary anymore. 

They look ... almost right.

(Note:  But it may be the ever-growing belly that's making things look more proportionate lately.  Ask me in eight weeks. :) )

February 03, 2010

We Can Work It Out.

The Dexcom seems fit enough.  I need to get my yellow legs in gear.(Great song.)

Now that we're back from our trip, it's time to reintroduce myself to the "swing of things."  While we were away, Chris and I were up late, eating fancy food at fancy restaurants (including desserts and carb-fantastic sweet potato french fries and gelato ... things we wouldn't normally eat but we devoured in spades - and in our mouths - all week long during the festival holy run on sentence), going to bed at 3:30 in the morning, battling the frigging hills, and waking up the next day only to do it again.  For nine days running.

It was exhausting. 

But now we are home.  And in the comfort of my own schedule, I can wake up early, eat a breakfast that doesn't include sausage (not the cat), get enough sleep at night, put my feet up as necessary, and get some exercise in.

Oh, the exercise part.  How you plague me.

I used to be awesome at getting to the gym.  Not to toot my own horn - more to toot Chris's, actually - but his dedication to the gym helped me keep my proverbial (and literal) butt in gear.  It was just part of our routine, and it was easy.  And the benefits were tremendous:  good health, pants that fit, and that feeling of "ooh, I'm sort of strongish."

But now?  As the baby belly grows and my sense of balance leaves the building for the next 75 days?  Exercise is hard.  Wicked hard.

Since we've been home, I've been back at the gym with Chris, only the workouts I'm doing now feel completely lazy-ass, compared to the ones I was doing before.  No weights (thank you, retinopathy), no jumping rope (thank you, bouncy belly), and no increased heart rate over 130.  

So I walk.  For like 40 minutes on the treadmill, without an incline and at a speed of only 3.0 miles per hour.  On paper (screen?) that looks wussy, but in reality, it's kicking my behind.  I'm not sure if it's the weight I've put on in the front or the fact that my lungs are squished in there, or maybe just because my whole body is completely different now than it was seven months ago, but just walking on the treadmill is a challenge these days.

I'm going to see how long I can keep exercising.  I've heard that many pregnant women make it to the day before they give birth, and I've also heard that the more active I can remain, the better my recovery will be after having the little baby.  Activity helps keep BSparl healthier, too, which is even more incentive to keep plodding.

Weird thing is, my blood sugars don't drop during exercise anymore.  In fact, they seem to go up a little bit.  Before becoming pregnant, I would disconnect my pump and exercise without insulin, but now I need to leave it attached.  And I sometimes need to bolus during the workout, depending on how the Dexcom is trending.  It's very odd, what my hormones are doing to my blood sugars these days.  I also had to increase part of my wee hours of the morning basal today, after two mornings in a row of waking up at 150 mg/dl.

"Kerri, you're rambling.  You realize that, right?  You're just rambling on about exercise and blood sugars and do you actually have a point with this post?"

Why thank you, Internal Motivational Speaker.  I appreciate you bothering me.  Yes, I'm rambling, but I'm just trying to get all these thoughts out before I lose them.  Which seems to be the case lately.

"Why don't you just tell them that the real reason you're fixated on exercise this week is because when you came home from Sundance, each cat had gained 5 pounds?  Now you have a trio of porkchops racing around the apartment?  Why don't you admit that Siah can't even fit under the couch anymore because she's too darn fat?"

Sigh.  I need to get back into the exercise groove. 

And apparently so do my cats.

November 04, 2009

Dexcom and Desperation.

For a few weeks, I had a tough run with the Dexcom.  Out of the five sensors I'd used in the last three weeks, three of them had gone kaput on me.  And by "kaput," I mean that I'd put in a new sensor after Las Vegas and it instantly gave me "???" instead of blood sugar results.  I've seen the triple question marks before, but usually the sensor synchs back up and rights itself.

Dexcom tossing "???"

But this time, the question marks hung out for ages.   Like hours, and then when it would finally ask me to calibrate, it would work for about 45 minutes ("work" being a loose term here, because it had numbers that were over 180 points off from my actual blood sugar) and then the SENSOR FAILED error would come ringing up.  Stupid error. 

Dexcom sensor - FAILED!

I thought it was just the one sensor, but it happened three different times in three different weeks.  Using the Dexcom, it seems, has helped me get my A1C act together, and since becoming pregnant, the Dex has helped bail me out of many, many unpredictable low blood sugars.  (Lows plagued me during the course of the first semester, relentlessly.  50s, 40s, and 30s coming to stay for a visit without calling first.  No symptoms, no warning, and no predictable time frame.  Without the Dexcom, I wouldn’t have woken up in time for those lows, and I don’t like to think about how far I could have dropped while sleeping.  Whoops, digression.  Sorry about that!)  

So I called my contacts at Dexcom, because they are aware of my pregnancy and how paranoid I’ve become about things lately.  (Actually, I emailed them at 2 in the morning because when the third sensor in a row kicked out on me, I flaked.  I sent them one of those “Sorry I’m a lunatic, but …” emails, and thankfully they got back to me early the next day.)

After a few email threads, Dexcom decided to FedEx out new sensors and help get me back on track.  And for some reason, these worked.  I’d heard from the Twitter crew and from some comments here on SUM that there appeared to be a certain batch of sensors that just weren’t cutting it.  I don’t have the “official word” on what the deal actually was, but I do know that a certain box of sensors just weren’t working right.  And now that I’m cracked into a new box, things appear to be working okay now.  

Which is a relief, because the Dex caught a 29 mg/dl as I was getting ready to leave the house the other day.  

“Holy shit, I’m 29?”  

Chris wasn’t home at the time, so I panicked a little bit.  Not a single symptom was on board, and I was freaking out.  I tested again to make sure, as I drank grape juice straight from the carton.  Yup, 31 mg/dl.  Dexcom was blaring its head off.  

Weird things happen when you’re low and don’t realize it.  Like you find yourself sitting at the kitchen counter, eating a whole bowl of Puffins cereal in one gulp.  Chris came home as I was inhaling carbs.

“Are you okay?”  

“Yeah.  I’m 29.  No symptoms.  This sucks.  I seem fine, don’t I?”

“You do.  You seem completely fine.”  The Dexcom went off again.

“Good thing that’s working again.  Did you have juice?”

“Drank it. I’m eating the whole box of Puffins now.”  Grinned through a mouthful of carby goodness.

When it works, it works.

I’ve been wearing the Dexcom on and off for two years now, but almost 24/7 for the past six months.  And not having it on, or having its integrity compromised through technical failure, etc. makes me feel absolutely naked.  It’s not a cure, it’s not a guarantee for tighter blood sugar control, but it’s the safety net I was hoping for, and now that my basal rates, insulin:carb ratios, and blood sugar trends seem to be unpredictable during these months of pregnancy, I’m leaning on it more now than ever before.

[Dexcom disclosure]

September 21, 2009

Hanging on by a Thread.

I will do just about anything to keep a Dexcom sensor stuck for more than seven days.  Wearing the sensor on my thigh has been very effective because my that location allowed for a little less friction in the summer months, thanks to skirts and summer dresses.

With a little maintenance (read:  using bandaids to help stick down the sides that threaten to peel), I've been able to go from barely seven days with a sensor to an 11 or 12 day streak.  This is a huge milestone for me because a few months ago, that thing would have been melting off my body after four days, at best.

This Dexcom sensor is hanging on by a thread.

But they look like garbage once I'm ready to pull them off.  (And you can see the outline of the bandaid I had slapped on there for a few days in efforts to keep the sides from peeling back.  Not ghetto at all.)

These sensors are expensive.  And I treat them with appropriate respect.  (Also, they sting a bit to put in, so once they're in, I want to keep them there for as long as humanly possible.)  Which is why when they fail, I'm frustrated.   

I had my first ever "Sensor Failed" on Saturday.  Once the sensor in the photo above peeled beyond my ability to save it, I pulled it off and reapplied a new one.  No pain, no worries, fired up that sensor and waited for the two hour calibration period to pass.

Only the thing kept throwing "???" in the box instead of that shuffling gray line.  

"What the hell?"

After a full hour of triple question marks, I hit "Stop Sensor" on the receiver and restarted it again.  Almost instantly, the triple question marks came back.  Then, about twenty minutes later, the receiver BEEEEEEEP!ed loudly and I saw this screen for the first time:

"Sensor Failed."

Oh come on.

Because I'm both stubborn AND cheap, I restarted that same sensor again.  And again.  I spent about six hours starting and restarting that same sensor, in effort to keep from having to pull it on its first day of work.  I even consulted the online product information to see if there was something I was doing wrong.  By the time I left my friend's house and headed home, the sensor had died three separate times.  I knew the thing was kicked, so I went home to reinstall a new one.

Two hours later, the second sensor of the day was up, running, and giving me results that were within 10 mg/dl of my meter.  Like it has been for the last three months.  Like it should, in my opinion.  And today I'll send a quick email to Dexcom and let them know that the sensor wasn't as snuggly as usual.

The Dexcom, in my opinion, helped me improve my A1C.  It helped me stay on top of my blood sugar numbers instead of spending a few hours at a clip ignoring them entirely, and when it BEEEEEEP!s in the middle of the night and alerts me to a low my body hasn't acknowledged with symptoms yet, I'm grateful.  

It's not a perfect technology.  But it's worth the effort.

[Dexcom disclosure]

June 30, 2009

Penguin Truck.

We're planning for a pregnancy, so I've been working tirelessly to stalk my blood sugars.  I'm wearing the Dexcom, testing regularly, and really aggressively chasing highs and lows in pursuit of that nice "between the lines" look on my blood sugar graphs. 

So when I changed my infusion set last night and neglected to take the 1.0 u bolus in anticipation of the high (which seems to be the only way I can keep the highs at bay after a site change), I knew I was in trouble.  Sweaters on my teeth, and my tongue thick with dehydration, confirmed by the 254 mg/dl on my meter.  I cranked up a correction bolus and sent it cruising in, along with some frustration and a few choice curse words. 

A few hours later, I was on the steady but seemingly safe decline, with the Dexcom keeping tabs and my meter serving to confirm.  No worries.  I ate a snack (cottage cheese with some frozen raspberries) before bed and snuggled against the pillow (read: cat) at a blood sugar of 187 mg/dl.  Higher than normal, but I knew it would continue to come down.

Didn't anticpate the 3:30 am wake-up call of BEEEEEEEEEEP!, though. 

I have no idea what my blood sugar was.  The Dexcom showed me only as "low" and I woke up crying, for some reason.  Chris was next to me, fast asleep, but I didn't wake him up.  I don't know why.  A bottle of glucose tabs sat on the bedside table but I didn't reach for them.  I don't know why.  The shape of my body was outlined in sweat on the bedsheet and my hair was sticky, and for some reason combing my hair down before I went to get juice took priority over eating something to correct the low. 

I don't know why.

I don't remember a lot of this low, and that scares me.  I was dizzy.  I was stupid for not waking Chris up and asking for his help.  I remember hearing the Dexcom wailing from the bedroom as I stood at the fridge in the kitchen.  I drank the juice directly from the carton, drinking well past my eight sips and gulpinThese guys can just go right to hell.g until I couldn't catch my breath.  Yet, I remembered to wipe down the floor to clean up what I spilled.  I don't know why.

Hitting that stride, hugging close to the center lane of 100 mg/dl, is really what I'm aiming for.  I've been doing better lately, so every time I'm way off target, I feel the symptoms too late for lows and very intensely for highs.  I know this is a signal that I'm in tighter control, but once I'm stuck in the spin cycle of high-to-low-to-high and back again, it's hard to climb out.  And a lot of time my morning number sets the stage for the rest of my day.  Last night's low blood sugar left me at 199 mg/dl this morning, and I still haven't settled back into range.  I feel frustrated, knowing my A1C is being drawn at the end of July.  But last night's events kicked my ass too thoroughly for me to focus on anything other than muddling through the day.

It's that pesky penguin truck again.  I hope the tire tracks aren't too visible this morning.  

June 24, 2009

Why I Wanted a CGM.

On my soapbox again.  Hello!I'm often asked about why I chose the Dexcom CGM over the Minimed, and I have plenty of posts here on SUM that talk about my experiences with the two devices:

And then fighting for insurance:

And after I had won insurance approval, Dexcom and I joined forces:

Phew!  But part of even starting this process was wanting to go on a CGM to begin with.  I'm often asked about the different continuos glucose devices and pros and cons of each, I get just as many questions as simple as this:  "What made you ready to go on a CGM in the first place?" 

I know that for going from injections to pump therapy, I was frustrated with the lows that were happening three times a week, and how my ex-boyfriend was constantly finding me motionless in the bed at 4 am, covered with sweat.  After 17 years of injections and after two years of an A1C that wouldn't budge, I made the decision to use an insulin pump.

After deciding to wear one medical device, it was easier to try another one.  A few years of pumping made me feel comfortable with the 24/7 attachment of a diabetes device, so when the continuous glucose monitors became more prevalent on the scene, my interest was piqued.  At the time, I was in a serious relationship, thinking about having children in the future, and realizing how my blood sugars still weren't running better, despite my increased education and effort.  It was time to try something a bit different.

With a CGM of any kind, there's a certain security that comes with it.  I feel more confident speaking at events when I can look at the graph on my CGM and see that I'm holding steady.  Same for getting in the car for long drives, or on a plane for a few hours.  After twenty plus years of only having snapshots of what my numbers were like, I now have access to the streaming video, so to speak, of continuous monitoring.

Yes, there's also the "Hey, you're a robot" component to this.  I can't lie.  When I look at my body and I see all these things stuck to me, in addition to the red dots of diabetes devices past, I feel a little overwhelmed.  But it's part of living with this disease. (Most of the time, I'm able to shake off the robot feeling and just let Chris call me Rosie.  Whoops - there's the digression.)  I actually feel okay with wearing two medical devices.  It's sometimes cumbersome and inconvenient, but for me, the pros outweight any cons.  I hear a lot of bad news about diabetes, about how this many years with type 1 can really cause a landslide of issues, about how life can be compromised.  And I don't want that. 

Regardless of what happens in my future, I want to make every effort to be as healthy as I can, both mentally and physically.  And I'm ready to keep trying.  That's why I blog.  That's why I raise awareness.  That's why I pump. 

And that's why I wanted a CGM.

May 27, 2009

Gelled to Perfection.

One thing I didn't pack last week on my vacation was my Dexcom, but I had my reasons.  Even though I'm working very hard to lower my A1C in preparation for starting a family and even though diabetes has been a big focus this year, I wanted a VACATION.  From just about everything.

So my diabetes moments on the cruise were minimal.  I brought my meter everywhere, wore my pump, and had glucose tabs stashed in my bag, but I didn't lament every number or guilt myself silly over every meal.  I ate, drank, and was quite merry, thanks.  

But when we got back last weekend, the first thing I did was put the Dexcom back on.  (Okay, that's a bit of a lie.  The very first thing I did was open the apartment door and greet the furry army with a "Hi, buddies!!!" and then I collapsed into bed.  But after I woke up?  Dexcom sensor slapped on my right thigh.)  While I traveled, I had a few high 200's and a nice, ripe 309 mg/dl thanks to some delicious dessert indulgences, so I wanted to get back on track and attempt to find the flatline again.

Smurfy little Dexcom receiver.

The people at Dexcom sent me two gel receiver "skins," very similar to the ones that Bernard wrote about ages ago.  On the Dexcom website, these suckers go for about $10 apiece. But they are wicked cool.  The original case that comes with the receiver is pretty bulky, making the receiver looks much bigger than it actually is.  The skins are nice because they offer up some protection and also give the device a more streamlined look.

And since I'm known for my grace (ahem), the skin has protected my receiver from two falls from my desk, a few tumbles from my bedside table, and countless tosses into my work bag.  Also, the bright blue case makes it a helluva lot easier to find in the mess that is my purse. 

So Dex and I are reunited.  And now that I've made another Joslin appointment for July - this time with my full pre-pregnancy team, including my endo, ob/gyn, nutritionist, and teaching nurse - I'm back to focusing hard on my numbers.

And logbooking.

(Sigh.) 

May 12, 2009

A Little Bit Naked.

For the last five months or so, I've been wearing the Dexcom with frightening regularity.  Having it on the bedside table or on the headboard became commonplace, and the receiver laying on my desk at work was as normal as my Blackberry sitting there.

The Dexcom Seven Plus upgrade bit made a difference for me, too.  It updates in accordance with my calibrations wicked fast now, instead of taking anywhere from 15 - 30 minutes to synch back up.  The trending arrows are awesome and very helpful for me, because my blood sugar skyrockets and tumbles fast at times.  I know when I heard about the new system I was a little "Ooooookay,"  because it didn't LOOK any different.  The sensors are the same, the transmitter is essentially the same (gray instead of black), and the receiver is the same.

I missed this thing.

Only it's not.

The size and shape of the device and it's components hasn't changed, but whatever they tweaked on the inside there really made a huge difference.  Since switching to the Seven Plus back in March, I've seen big changes in how this system performs.  It was accurate enough before, but now it's scary accurate.  To the point where I've eaten based on double-down arrows, and I've conservatively corrected the highs.  (Note to readers:  CGMs aren't supposed to replace blood tests, so this is definitely a "do as I say, not as I do" moment.  Test before you treat any number.)

So anyway, I'm all nice-nice with the Dexcom these days.  But just like with the pump, my skin gets a little irritated from overuse.  Shuffling around pump infusion sets and Dexcom sensors for weeks on end, coupled with my abdomen avoidance techniques, left my hips and thighs a little tender.  I needed a few days to let my sites heal.  So I went home to RI last weekend without my Dex.

And I felt a little bit naked.

I didn't miss the sensor being on me, but I felt weird not having access to that information.  I took my mother out to breakfast for her birthday on Saturday morning and I felt the need to test three times over the course of a three hour breakfast because I "needed to know" how I was trending.  Same thing at dinner that night.  I've grown accustomed to the graphs and charts and instant blood sugar information, and being without it made me feel exposed.  My numbers were roaming around unsupervised, or at least not with the supervision I was used to. 

I went to calibrate it before bed and didn't realize it was MIA until Chris said sleepily, "It's at home."  I spazzed out when I couldn't find the receiver in my purse.  And when we were driving on 95 on the way back, I checked the center console (where it lives when I drive) and actually felt sad that it wasn't there.  I missed it - is this possible?  To miss a device? 

So weird.

I wondered how long it would take for this to happen.  I felt the same way about my pump when I took it off two summers ago for a white water rafting trip.  I was used to the pump, so to be without it was odd.  And now, I'm finally used to the Dexcom, so taking a break for a few days threw me off my game.  Even though I am not always comfortable wearing the physical hardware, I'm more comfortable managing all this diabetes crap when I'm wearing the devices.  More information, at least for me at this stage in the game, is better.

The Dexcom is back on.  I haven't decided fully if it will travel on our cruise with us, but at least for now I'm fully dressed.

[Dexcom disclosure]

March 24, 2009

French Fried.

Chris has a crush on these things.Last weekend, Chris and I went out on Saturday night for his birthday.  And because he is a Francophile and borderline crème brulée addict, we revisited an excellent French bistro in Brooklyn (that we were introduced to by some wonderful friends). 

We drove in a found a parking spot right across the street from our destination (stroke of freaking good luck, that)- Moutarde in Park Slope, and we were right on time for our 8:30 reservation. 

And we ate.

Oh how we ate.

We started with slices of celery and peppers dipped into an array of spicy mustards.  There was freshly baked french bread with creamy butter.  A shared appetizer of escargot, entrees of duck confit and hanger steak with frites (read: fries) - we were beyond indulgent.  To round out our meal (and our bellies), we had not one, but TWO desserts - crème brulée and two profiteroles with ice cream and covered in warm chocolate sauce.

My blood sugars were screaming at the very notion of these noshes. 

"Nooooo!  Kerri!!!   You'll end up at 400 mg/dl, stupid!"

"Quiet, you.  I'm having a night off from your hollering."  

My husband and I cleaned our plates and topped our meals off with coffee (me) and cappuccino (Chris).   

"So how is your birthday going?"

Francophile Sparling leaned back in his chair, smiling.  "This is great.  I loved this.  I love French food!"

I reached into my purse and consulted the Dexcom, to see if my numbers were started to go berserk.  I saw a flatline - 142 mg/dl and steady.  

"Dude, I think I did this right.  After all that food, I'm barely 140."

"Nice.  Can we get another profiterole?"

I love a good night out with excellent food, excellent company, and excellent blood sugars.  A few hours later, when we were climbing into bed, I checked the Dex again and saw that I was 103 mg/dl with a little arrow pointing straight down, showing that I was falling slowly, but still falling.

Meter confirmed:  97 mg/dl.

"Bah.  I must have over-bolused.  I'm going to grab a swig of juice."

Face-planted into the bed and slowly digesting thousands of French calories, Chris murmured "Mmm hmm."

I took a drink from the grape juice bottle by the bed and settled in beside him, feeling cocky about our indulgent dinner and it's lack of effect on my numbers.

So didn't I feel like a tool when the Dex started singing at 5:30 in the morning, announcing my 271 mg/dl to the entire room?   Sweaters on teeth, that instant "Oh my God I have to pee" feeling, and my tongue weighing about 8 lbs - the whole mess. 

I never, ever remember that the fat hits my blood sugars so much later.  (And we ate a lot of fatty foods!)    Stupid overconfident Kerri.  You done been French fried.

"Kerri, we told you.  We so told you."

"Enough!  I am fixing this now and besides, it was worth it." 

"The high?"

"Nope.  The crème brulée!" 

March 20, 2009

Dexcom Seven Plus: First Impressions.

So far, so good.

Last night, I installed my first Dexcom Seven Plus sensor.  "First" might be a bit of a misnomer, because the sensors that actually go into my body are still the same as the ones I used previous.  I have a new transmitter (the little plastic part that clips into the sensor housing) and a new receiver (the external device), which are the pieces that have been upgraded.  

Dexcom has a good overview of the new system and its features, including a video that walks you through the upgrades.  They can give you all the technical jargony stuff.  :)

For me, I've put this new sensor on my left thigh and after the initial pinch, I was good to go.  The hardware on the Seven Plus works almost exactly like the old system, with a two hour calibration period, same sensor insertion devices, and the same general gist.  What's new is the software inside the receiver.

When I tried out the Minimed system last year, I liked the fact that the MiniLink had rate of change arrows on the CGM.  So when I looked at my pump, I could see my blood sugar graph and could also see if I was plummeting or rising quickly.  I was sorry that Dexcom didn't have this option before - but now they do.  The new Seven Plus has those rate of change arrows, and you can also set an alarm to BEEEEEEEEEP (if you want) when you're rising or falling too quickly. 

Oh so dexy ... I mean, sexy!

And regarding BEEEEEEEP!s, there are more beeping options on this thing, too.  You can set an alarm for a high, low, rise rate, fall rate, and sensor out of range (i.e. when the cat takes off with it in the middle of the night and you don't realize it until you wake up without it).  There are snooze alarms for the high and low levels, so I have mine set to BEEEEEEEP! at a low and then give me 30 minutes to correct and climb, instead of beeping its head off every five minutes for hours.  (Nice.) 

Another feature that's been added is the ability to add "events," like exercise, food, insulin doses, and health info - much like the One Touch Ultra meters.  I've been consistent so far with entering this info (read: it's only been 12 hours with this thing attached, so I'm in a bit of "new device euphoria" and I have no clue if I'll stick with being so tuned in), and if I can keep up, it will make the records from the Dex pretty comprehensive.

Dexcom 2 Software screenshot.  Sorry this caption wasn't that interesting.

The software is pretty good this round, able to download information from past sensors, instead of just the most previous one.  I took some screenshots of the software and gave my notes on Flickr, because honestly, I'm not terribly techy and writing on and on and on and on ... zzzzzzz ... and on about software upgrades could make me yawn my face off.  Overall, the software is good and tracks what I need it to track and if I was able to make my patient profile avatar into a picture of Siah's head, I would.  You know it.

Overall, I like the upgrades.  And the upgrade is universally available to all Dexcom users (EDIT:  It's available immediately to all new customers.  Existing ones can get it in May.  I'm not sure why that is, but if anyone from Dexcom is reading and wants to leave a comment, please do!), but I don't know the details of insurance coverage and cost.  I am glad that Dexcom is willing to push out new options as they become available, instead of waiting for a full device overhaul.  I'm hopeful that the next round of developments will help reduce the size of the sensor and the receiver. 

I'll let you know next week how a few days worth of experience with this system feels, but in the meantime, feel free to check out my Flickr photos of the Dexcom Seven Plus.  If you have questions, I'll do my best to help.  (Keep in mind:  I'm slightly clueless.)

Now I'm heading to work in this snow squall (WTF?) - what is that about?  I thought today was supposed to be the first day of spring??  More later!

[Dexcom disclosure]

March 19, 2009

Bad Larry and the Dexcom.

When Chris was traveling last week, I had to install (Install?  Is that the right word or does that make me sound like a TRS-80 from Radio Shack?) a new Dexcom sensor.  Usually, with his help, I wear the sensor on the back of my arm and he takes care of securing it.  But since I was flying solo for this installation, I decided to try a new spot.

So I slapped that bad Larry onto my right thigh.

The aforementioned "Bad Larry."

(Note: A Bad Larry is defined by the online Urban Dictionary as "an adjective that describes something that is sweet or badass."  This note is purely for FYI purposes and not to be confused with the Good Larry, aka Larry Bird.)

To be completely honest, that thing hurt like a bitch going in.  Usually the arm placement for sensors doesn't hurt much at all and the whole installation process is over without much fanfare.  But this thigh one made me jump and skip around cussing like Yosemite Sam (again).  I immediately wanted to pull it out and put it somewhere else, but I recognize the value of these things and I did not want to waste one just because it was a stinger.  

So I sucked it up and slept carefully that night, avoiding any pressure on that tender spot.  Thankfully, by about noon the next day, the sensor had settled in and either took out all the local nerves (kidding) or my body finally adjusted to the placement.  It was snug against my jeans and didn't create too much of a bulge.

Because I do not want a bulge in my jeans.  (Hey Google - have fun with that one!)

A plus to wearing the sensor on my thigh seemed to be the lack of rubbing on the edges.  Granted, the thing was ringed in blue by the sixth day due to jeans, but it stayed relatively unfrayed (that photo is from Day 6) and wasn't in the way much.  A minus to this spot may have been the constant rubbing of clothes, because it crapped out on me on the evening of the sixth day, throwing a dead sensor error.  Was it the rubbing that caused this, or was the sensor kaput on me too early?  I'll touch base with the crew at Dexcom to see what the deal could be and I'll let you know.

But that thigh sensor was my last run with the Dexcom SEVEN Ye Olde (But New) Dexcom Seven Plussystem, because my new Dexcom Seven Plus arrived this week, and I'm giving that a go tonight.  The upgrades are very software based, with the receiver and the sensors remaining the same size, but now there are rate of change indicators and ways to log food, exercise, etc. on the receiver, making the logbooks from Dex significantly more useful.  AND there is a 1, 3, 6, 12, and 24 hour graph screen, which I'm stoked about. 

More details on the Seven Plus tomorrow, but for now, I'm trying to decide where to stick that next bad Larry.  ;) 

(And in keeping with my full disclosure, these supplies are provided to me in accordance with my sponsorship agreement.  You can also find my grinning head in their information brochure - if you dare to download.)

March 12, 2009

When They Match.

My coworker has a special knack for matching.  Her shoes match her shirt with precision.  Her earrings and her bracelet have the exact same color purple in them.  Her headbands even match her pants which match her socks which match her bag.  In my mind, she has a whole frigging wing of her house dedicated solely to fashionable accessories.

Total matchy-matchy.  I’m always impressed.  I do not have a talent for this, and her outfits amaze me daily.

But there are moments when I have some matchy-matchy magic.  

The Dexcom isn’t meant to replace blood sugar testing, and usually when it BEEEEEEEP!s, I confirm whatever it’s hollering about with a blood sugar test.  I watch the line and see if I’m cruising upwards, falling slowly, or holding steady in a (hopefully) relatively flat line.  BUT when the CGM and the meter are just a point or two away from one another, I can’t help but mentally high-five my technology.

I like it when this shit matches.

I like when things work.  And better, I like when I work – numbers like these make me break out my camera because I want to capture that moment of success.

Small victories:  I haz them, too.

February 12, 2009

Staying Stuck: The Dexcom Sensor Condundrum.

I've been using the Dexcom on and off for a year now, and most often, I don't experience accuracy problems.  I also don't have lot of issues wearing the sensor (especially now, in the winter, when most of my body is under some kind of clothing).  Overall, it works well for my diabetes management.

But.

There's that sticky issue.  

Or, better said:  the unsticky issue.

The sensors are FDA approved to last for seven days.  (Hence, Dexcom SEVEN.)  But I'll be damned if I can get it to stay stuck for more than five days.  Between my morning shower before work, my excursions to the gym five days a week and the subsequent shower at night, and the regular wearing clothes/sleeping/moving around bit, that sensor comes loose before its time is technically up.Hair dryers + Dexcom + SkinTac = Awesomely stuck

I've tried several ways of keeping the sensor stuck, and after a ton of trial-and-error, there seem to be a few methods to my madness.  Here they are, alphabetically arranged by their last letter:

SkinTac.  This stuff is the shit.  Seriously.   SkinTac is made by a Rhode Island company (yay Rhode Island!) and it helps keep the sticky adhesive stickier.  I run the SkinTac pad around the inside of the sensor, staying away from the wire itself, and then I put the gauze against my skin.  Chris (who almost always helps me apply a new sensor) then uses the SkinTac to really soak the outside of the gauze pad to ensure it's secure.  A little blast of heat (more on that in a second) and the sensor is stuck solidly.

Hair dryer.  Most often, I'm wearing my sensors on my arm because it's the most out of the way place and one that has unused space to spare.  After I cover the sensor gauze with SkinTac, Chris points the hair dryer at the sensor and dries it on a very low heat until it's completely dry and adhered to my skin.  A little blast of heat keeps the tape dry and also keeps it from peeling back when I put my arm through a sleeve.

Long Sleeve Shirts.  Once the sensor is in place, it helps me to keep a sleeve over it.  During the work day, this is usually the case, but for the gym, I often wear tank tops.  However, it's not the daytime activities that wear and tear my sensor most.  I've found that wearing a thin, longsleeve shirt to bed to protect the sensor from being jostled while I sleep.  It's like extra insurance that the edges won't peel back. This works for a sensor on the arm, obviously.  Otherwise, you're sporting sleeves purely for fashion reasons.  ;)

Playing Memory.  Sometimes I just need to plain remember where the hell I stuck the sensor in the first place.  With pump sites and CGM sensors scooting to new homes on my body every few days, I need to keep in mind where the sensor is so I don't accidentally rip it off.  Wearing it on my arm can cause some problems when putting on a sports bra or even a regular bra, so I need to be careful and make sure the bra strap completely clears the sensor when I'm getting dressed or undressed.  This isn't so much a "tip" as a knock on my apparently limited memory. 

Maybe this information will STICK with you?  Or are we all becoming a bit UNGLUED?  Whoops, looks like my caps lock is STICKING.  Maybe I should quit with these puns while I'm still ADHERED to my desk.  (Not.  Funny.  If you have a better pun, STICK it in the comments section.)

[Dexcom disclosure]

Staying Stuck: The Dexcom Sensor Condundrum.

I've been using the Dexcom on and off for a year now, and most often, I don't experience accuracy problems.  I also don't have lot of issues wearing the sensor (especially now, in the winter, when most of my body is under some kind of clothing).  Overall, it works well for my diabetes management.

But.

There's that sticky issue.  

Or, better said:  the unsticky issue.

The sensors are FDA approved to last for seven days.  (Hence, Dexcom SEVEN.)  But I'll be damned if I can get it to stay stuck for more than five days.  Between my morning shower before work, my excursions to the gym five days a week and the subsequent shower at night, and the regular wearing clothes/sleeping/moving around bit, that sensor comes loose before its time is technically up.Hair dryers + Dexcom + SkinTac = Awesomely stuck

I've tried several ways of keeping the sensor stuck, and after a ton of trial-and-error, there seem to be a few methods to my madness.  Here they are, alphabetically arranged by their last letter:

SkinTac.  This stuff is the shit.  Seriously.   SkinTac is made by a Rhode Island company (yay Rhode Island!) and it helps keep the sticky adhesive stickier.  I run the SkinTac pad around the inside of the sensor, staying away from the wire itself, and then I put the gauze against my skin.  Chris (who almost always helps me apply a new sensor) then uses the SkinTac to really soak the outside of the gauze pad to ensure it's secure.  A little blast of heat (more on that in a second) and the sensor is stuck solidly.

Hair dryer.  Most often, I'm wearing my sensors on my arm because it's the most out of the way place and one that has unused space to spare.  After I cover the sensor gauze with SkinTac, Chris points the hair dryer at the sensor and dries it on a very low heat until it's completely dry and adhered to my skin.  A little blast of heat keeps the tape dry and also keeps it from peeling back when I put my arm through a sleeve.

Long Sleeve Shirts.  Once the sensor is in place, it helps me to keep a sleeve over it.  During the work day, this is usually the case, but for the gym, I often wear tank tops.  However, it's not the daytime activities that wear and tear my sensor most.  I've found that wearing a thin, longsleeve shirt to bed to protect the sensor from being jostled while I sleep.  It's like extra insurance that the edges won't peel back. This works for a sensor on the arm, obviously.  Otherwise, you're sporting sleeves purely for fashion reasons.  ;)

Playing Memory.  Sometimes I just need to plain remember where the hell I stuck the sensor in the first place.  With pump sites and CGM sensors scooting to new homes on my body every few days, I need to keep in mind where the sensor is so I don't accidentally rip it off.  Wearing it on my arm can cause some problems when putting on a sports bra or even a regular bra, so I need to be careful and make sure the bra strap completely clears the sensor when I'm getting dressed or undressed.  This isn't so much a "tip" as a knock on my apparently limited memory. 

Maybe this information will STICK with you?  Or are we all becoming a bit UNGLUED?  Whoops, looks like my caps lock is STICKING.  Maybe I should quit with these puns while I'm still ADHERED to my desk.  (Not.  Funny.  If you have a better pun, STICK it in the comments section.)

[Dexcom disclosure]

January 29, 2009

Abby and Dex.

(This is embarrassing.  But true.)

At night, when I go to sleep, I tuck myself in underneath the down comforter and the blankets, I snuggle up against my husband, and I fall asleep, usually with my head about halfway on the pillow.  And Chris and I sleep.  For about twenty minutes.

Until the cats come calling.

Somehow, all 16 lbs of Abby the Fat Cat manages to launch onto my side of the bed.  (I swear the bed lists to one side.)  And instead of curling up at the foot of the bed, like a normal animal, she takes up residence on my pillow. She tries to stick her paws in my ears, she snores, and she completely disregards the fact that the pillow is meant for MY head, not her whole fuzzy body.  (Usually, I end up sleeping on about 1/8 of the pillow.)

Unfortunately for Abby, things have changed in the Sparling household.  Not only is there a Chris and a Kerri in the bed, but there's also a Dexcom.  The Dexcom hangs from a headband that I have wound around the headboard of our bed.  That way, if it buzzes, Chris and I both are certain to hear it.

And two nights ago, the alarm on that sucker sounded at 3 in the morning.  Just as the sun was stirring, the Dexcom BEEEEEEEP!ed and I vaulted up from the bed.  Unfortunately for Abby again, the receiver was sitting on her back, and she also freaked out.

BEEEEEEEEEEEP!

"Meow!!!"  Her claws come out and sink into my head.

"Ahhhhhhhh!" 

BEEEEEEEEEEEP!

Unzip meter.  Shunk.

35 mg/dl.

"Chris.  I need juice."

'Mmmm hmmm."  Juicebox with orange juice in it appears out of nowhere.  

Slurp.

"Meow!"

BEEEEEEEEEEEP!

"You okay?"

"I will be in a minute."

I'm sweaty, shaky, mouth sticky with orange juice and sleep.  It's three in the morning and I want to go back to sleep.  But I know I should wait a few minutes, so while I do, I take picture of what a 3 am low looks like:

You do realize there is very little room for my head here...

 At least she keeps my head warm.

January 28, 2009

If You're Going to Stare ...

I like this image, so I'm using it again.  :)Last night at the gym, I put my bag in the locker and took off my sweatshirt.  Wearing my black yoga pants, sports bra, and a tank top, I went into the bathroom section of the locker room to put my hair in a ponytail.

Two other women were at the sinks, chatting in Spanish and washing their hands.   They were standing to my left and as I raised my arm to put the elastic in my hair, I noticed that both women had stopped talking for a minute and were staring at my arm. Staring like I had moldy peach stuck to my arm, or maybe one of those bizarre happy spiders

Then I remembered that the Dexcom sensor is comfortably resting on the back of my left arm.  Facing them.  

I had a quick surge of "Grrrrr," as in "What are you staring at, woman?  Never seen a CGM sensor before?" ... then I had to check my attitude.  No, they probably haven't ever seen a continuous glucose monitoring sensor before.  Just because it's something I'm used to doesn't mean it's something they are used to.  After yesterday's post purge and your wonderful and inspiring comments, I felt ready to cast off some of this anger and try, instead, to help.

So I decided to smile instead.  

"I'm sorry, I don't mean to notice that you're staring."  Gestured to my arm.  "This thing - it's for my type 1 diabetes.  It's a glucose monitor."

"Oh my goodness, I did not mean to stare," said the woman in the green shirt.  "I was like, 'Is that an iPod thing or something?'  I have never seen that kind of thing before."

Her friend with the glasses leaned in.  "For diabetes?"

"Yeah.  I know it doesn't look completely natural, and I would stare, too, if it wasn't something I was used to." Glasses and Green Shirt smiled back.  "It's cool.  I just didn't want you wondering if I was some kind of cyborg or something."

Green Shirt laughed.  "Cyborg?  No, chica.  It's interesting looking.  I was waiting for, like, the music to come out of it or something.  But I didn't mean to stare.  Lo siento, my friend."

"Not a problem at all.  Have a good workout!"

I left the locker room and went to do my workout.  After I was done, I went back in to grab my sweatshirt and saw Glasses and Green Shirt getting their gear together.  Flashed them a quick smile.  Glasses smiled back.  Green Shirt tapped her left arm and gave me a knowing nod.

Some people can try to bring you down.  But others, even strangers, can raise you up.  

[Dexcom disclosure]

January 22, 2009

BEEEEEEEEEP!s and Basals.

Damn diabetes juggling act.It's January 22, and I've been sticking with my New Year's resolution of keeping a Log Book.  (Said Log Book is currently in my home, all current and three-hole punched and was almost eaten once by Abby but then I put it in the bookcase so now it's safe.)  And after taking note of all the highs I've had in the morning hours, and the weird drops I'm experiencing just before going to the gym at night, I decided to do a little basal tweaking.

Here's the disclaimer:  Talk to your doctor before tweaking your basals.  Kerri is not a licensed CDE or a medical professional of any kind, and quite frankly, if you follow her advice, you may end up tucked inside of a banana for all eternity.  [See also:  Siah.] 

I don't take a lot of basal insulin throughout the day, but I do use many basal flucutations.  It's not one steady dose for me.  I range from .45 u of Humalog in the afternoon hours to about .75 u in the early morning hours. For a while, this worked out pretty well.  But maybe it's the lack of birth control pill hormones, or the absence of wedding-related stress, or maybe the new mousepad I have at home is shifting the tides ... in any event, I needed to make some adjustments.  I could see the trends happening by watching the Dexcom screen, so I knew this was more than just a fluke thing.  (The Log Book confirmed my suspicions.  Who'd have thought that logging could be useful!)  The Dexcom was hollering at me in the morning - BEEEEEEEEEP!ing to the point where my coworkers noticed.  

"You okay?"

"Yeah.  Frigging beeping.  I have diabetes."

Laughter.  "Oh yeah."

So on Monday morning, after another frustrating BEEEEEEEP! confirmed by a meter check showing me at 267 mg/dl (thank you, glucose goblins), I tinkered around with the patterns in my pump.  I dialed up another .2 u for my mornings, hoping to stave off the highs. 

It worked.

Yesterday morning, I woke up at 6 am with bricks hanging from any firing synapses in my brain.  The Dexcom was BEEEEEEP!ing from the headboard of the bed (where it stays during the night so Chris can see it and hear it, too) and I woke slowly.  Moving without thinking, I unzipped the meter case and went through the motions.  41 mg/dl.  Fantastic.  Seeing the number cut a few bricks loose, and I was able to shuffle off into the kitchen for juice.  (Yes, there were reaction treaters in my bedside table.  No, I didn't use them.  Instead, I found myself in the kitchen with a huge knife, cutting a slice of a brownie from the container in the fridge.  Sharp knife + Kerri when she's low + wee hours of the morning could = disaster, but thankfully no fingers were severed during the course of my low.)

Reaction treated, I went back to bed, crumbs still on my shirt.  I rested my head against the pillow and the Dexcom howled at me once more, showing me the slow bell curve towards a low that had been happening for over an hour.

"No, I heard you.  It's cool now.  Leave me alone."

Chris stirred.  "You're going off.  You're beeping.  Did you hear the beeping?  You're low."  Talking in his sleep, the poor guy.  He's on autopilot, too.

"I treated. It's okay now." 

It's a little research, a little trial-and-error, and a whopping dose of blind faith required for mucking with basals. Hopefully over the next few weeks, I can make slow adjustments to this basal crap and eliminate some of those frustrating highs.  Even though I'm sleepless some nights due to the Dexcom, I'm grateful to be able to see those graphs and lines and make adjustments to my insulin doses accordingly. 

If only it could keep me from juggling knives while I'm low.  I think I need a whole separate alarm for that. 

[Dexcom disclosure

January 12, 2009

Diabetes Rebellion.

The first rule is ... test!When the Dexcom sensor goes kaput, I usually take a day or two off before slapping a new one on.  Sometimes I want to let the site heal a bit and reuse the same location, and other times I just want a quick break before committing to it again for another six days or so.

Most often, these "days off" fall on the weekends.  I usually put a new sensor in on Sunday nights or Monday mornings before work and wear it straight through to Saturday morning. At work, at the gym, and throughout the night, that sucker BEEEEEEEP!s when I'm high or when I'm trending low, and I react accordingly.  I don't test as often on these days - maybe five times a day versus my pre-Dexcom 11-15 times - but I feel like I have a good handle on things, for the most part.

So why is it that, on weekends, my blood sugars fall to pieces?

I can't figure it out. 

And then again, I sort of can.  Over the last month or so, I've become like a diabetes rebel on weekends.  I go to bed at two or three in the morning.  I sleep until 11 am.  I eat French Toast (with sugar-free syrup, but still - holy carbs) on Saturdays and my intake of coffee is as constant as insulin.  I skip the gym and watch tv and generally become a lazy bum.

And, of course, this all goes down when I'm sensor-free.

This particular weekend, I had a glorious 374 mg/dl and a sneaky 38 mg/dl.  We went to the movies on Sunday afternoon to see Valkyrie and I hadn't tested recently before heading into the movie.  During the course of the film, I felt extremely sleepy and felt my eyelids becoming heavy at times.  After we drove home, I tested and saw a grim 374 mg/dl staring back at me.

Fantastic.  "I felt this one, yet I still didn't test.  What the hell is wrong with me?  I'm pissed - it's like I start sliding down that slope and it all goes amuck."

"Did you bolus?"  Chris asked.

"Yeah, I just did.  I just feel stupid."

"You'll come down.  It's okay."

A few hours later, after hanging out at the house, I tested arbitrarily.  I felt completely fine - no headache, no sweaty forehead, no shakiness.  I wasn't pale, my eyes weren't heavy-lidded, and I didn't feel lightheaded at all.  Yet a 38 mg/dl was the result that greeted me this round, and I didn't feel even a glimpse of a symptom.

Tested again and confirmed:  34 mg/dl.  Definitely low.

I drank juice, I sat on the couch, and I waited patiently (or at least patiently for me, which meant I didn't throw anything).  And as I waited for my blood sugar to start coming up, the symptoms came slamming into me.  I was dizzy, to the point where I felt unable to stand up.  Chris came to talk to me and I couldn't string a sentence together, only able to communicate in short bursts.  "Low.  Yes, drank juice.  Waiting.  Love you, too."

From 374 to 38 - a drop of over 330 points.  This doesn't feel good and it isn't healthy for my body, yet it happens sometimes.  Even when I'm paying attention and "following the rules," there's still something I've missed.  I didn't test often enough.  I neglected to account for some of the food I ate.  I took the weekend off from the Dexcom.  I'm battling myself.  It's a diabetes Fight Club.  (The first rule is to not blog about fight club, but I've already blown it.)

I'm feeling frustrated these days and I'm not sure where to go from here.   But at least with this kind of rut, I can flip things towards "change" at any moment.  All ... I ... need ... to ... do ... is hit the switch.

January 05, 2009

Dexcom Disclosure.

Dexcom is now a sponsor of SUM.I use a Dexcom CGM.  (This isn't new news, but bear with me.)  During the course of the last year, the folks at Dexcom took notice of my bloggish ramblings.  And thanks to my honest feedback (yes, I told them that their device is the most comfortable for me, but the adhesive still needs work) and their support of the diabetes community, they've decided to sponsor me here at Six Until Me and provide my Dexcom products gratis.

I am very, very proud to be part of this agreement, and I'm also very grateful.  Even though my sensors are now covered by insurance, copays and deductibles are still what they are, and I'm thankful for any financial assistance that can come my way during these tough economic times.

However, I wanted to let you guys know what the deal is because I don't want there to be any questions about my relationship with different companies.  Disclosure is the responsibility of the blogger, and I wanted you guys to know about this agreement as soon as the proverbial ink was dry on the contract.  To be clear, yes, Dexcom is giving me my sensors for free.  They are now a sponsor of this blog.  They are going to be placing an ad here in the coming weeks, and you also may see me in their ad campaigns.  And I am using their product.

But it's important to note that my decision to use their product did not stem from a sponsorship agreement.  As I've written before, I tested the CGM models that were made available to me and made my decision to move forward with Dexcom based on my actual user experience, and prior to any agreements between myself and the company.  During the course of drafting this sponsorship agreement, I spoke at length with many of the folks at Dexcom and they're well aware that everything I write about Dexcom won't always be favorable (nothing is completely awesome - these technologies are still in development across the board), but what I say about their product will always be honest.  And unedited.  (And hopefully spelled correctly.) This is the disclaimer that has been provided by the Dexcom legal team and is now living in the disclosure section of my site:

"DexCom is a sponsor of www.sixuntilme.com and provides DexCom products to Kerri.  All content is that of the author and not reviewed or approved by DexCom."

So I'll continue to discuss the pros and cons of Dexcom'ing, with honest feedback about its accuracy, the BEEEEEEP!s, how it makes me feel emotionally, the flipping adhesive problems, and the moments when it bails me out of a potentially difficult diabetes situation.  The one things I'm now biased on are the financial implications of using a CGM.  I will not be paying for my sensors during the course of this sponsorship, so when a sensor comes loose after just a day or when the accuracy is spazzing out, I can't properly convey that feeling of "Arghhhh, frigging expensive sensor waste!"  But I do know what it's like to use this device and to fight for its coverage.  And I also know what managing diabetes has been like for the past 22 years, so I'm no stranger to the expense of this disease.

There's my moment of disclosure.  If you have any questions about this, or concerns about anything, please let me know.  I'm doing my best to give a true and honest perspective to you guys, and I want to make sure everyone knows where I stand here at SUM.  I work for dLife.  I'm sponsored by Dexcom.  And, if given the option, I would sell my soul to Nikon for making such a stellar camera.  But I want to be honest with you guys and I also wanted to share this exciting (at least to me) news, so now you know.  :)

December 22, 2008

Dexcom Pros and Cons.

As with everything diabetes-related (or maybe just life-related), there are pros and cons to this whole continuous glucose monitoring thing.  For those of you who are still thinking about whether you want to make this CGM leap, here are my pros and cons of CGMing to shed some light on the subject.

CGM CONS:

The sensor is bulky.  The sensor isn't tiny (about the size of an iPod shuffle), but it's held securely down by the adhesive gauze, so once it's in place, I can't feel it.  This is a big deal for me, since the Minimed CGM was painful for me.  However, it's visible underneath the sleeve of my shirts when I wear it on my arm and it's slightly uncomfortable to sleep on when it's on my back.

Can be "too much information."  Having blood sugar updates every five minutes is awesome, until you find yourself checking it every five minutes and obsessing over each result.  I needed to be psychologically ready for a CGM, and I need to be able to keep it from ruling my life. 

Receiver is enormous.  The Dexcom receiver is pretty big - bigger than my Blackberry - and it's cumbersome to wear.  I usually keep it on my desk, in my purse, or in my coat pocket when I'm out.  At night, I strap it to the headboard of the bed using a headband.  Not a big deal, but it's hard to miss.  Especially when it ...

Beeeeeeeeeeeps! The beeps are LOUD.  Mega loud.  Loud enough to wake me up during the night if I'm low (thankfully), but during the quieter parts of the workday, it's loud enough to distract my coworkers.  I recognize that the beeping is important, but it's not always convenient.

Adhesive sort of sucks.   This is my biggest compliant about Dexcom sensors.  The things do NOT want to stay stuck for more than five or six days.  I shower twice a day (before work and after the gym) and I wear clothes that rub up against the sensor, no matter where I place it.  Even with SkinTac, the edges of the sensor start to peel up at about the five day mark, and it's loose and ready to fall at the 7 - 8 day mark.  (And sometimes, the SkinTac and the Dexcom adhesive and a not-so-helpful bandaid create a huge and ugly problem:  frigging ouch.  See the photo on Flickr for a full rundown.) 

Ouchy Dexcom

I do not like when a $60 sensor starts to peel away.  This is highly annoying.

Insurance coverage battles. While others have had their requests approved without batting much of an eye, my insurance coverage for the CGM had to be fought for.  I battled my insurance company for over eight months before receiving my approval letter.  The insurance hurdles are a definite con, and might make some people reluctant to fight for their right for a CGM.  (Cheerleader note:  But don't let it stop you!  Go for it!)

Doesn't feel "sexy."  (Yes, I know this "shouldn't matter," but these are my personal pros and cons, so roll with me, okay?)  With the pump infusion set stuck into one part of me and the CGM sensor in another, wearing two devices doesn't exactly feel like I'm ready to model for Victoria's Secret.  There have been plenty of times when a moment has been interrupted by the CGM beeping or the sensor getting stuck on my clothes and whatnot. 

CGM PROS:

Low blood sugar safety net.  This was a huge part of why I wanted to use a CGM in the first place:  hypoglycemia unawareness.  I was exhausted and frightened of the lows at 3 am, so having the added safety net of the CGM has been a huge improvement.  The CGM does its job and protects me from plummeting blood sugars.  When Chris is away on business, he prefers that I wear the CGM to keep an eye on those lows.  It makes me feel safe, and I value that "pro" above all others.

Helps me avoid staying high.  My body reacts to blood sugars that are over 260 mg/dl or so, but those 160's and 180's often go unnoticed.  The Dexcom helps me wrangle in these "minor" highs and tighten up my blood sugar standard deviation overall.  Staving off both the lows and the highs will be particularly helpful during my future pregnancy.

Excellent for exercise.  I go to the gym at least five days a week, and my workouts range from walking/jogging on the treadmill to cardio circuit training.  The CGM has been AWESOME at detecting fluctuations in my numbers while I work out, helping me avoid those crash-and-burn lows at the gym and also the highs that sometimes crop up after a hard workout.  (And it was great on our hikes when we went to Acadia - excellent tool!)

Driving safety.  I spend a lot of time in the car driving back and forth to RI, and the drive time is anywhere from 2 1/2 hours to 4 hours (depending on traffic - I hate CT highways).  Having the Dexcom in the center console next to me while I travel is another big bonus.  With hypoglycemia unawareness and blood sugars that seem to be affected as much by my moods as by what I'm eating, having an extra eye on those numbers is crucial to keep be safe behind the wheel.

Integration-free works for me.  I trialed both the Minimed CGM and the Dexcom and for me, the Dexcom being a seperate device worked best for me.  With the Minimed CGM, I couldn't hear the pump alarming in the night because it was buried underneath the blankets.  Having the Dex receiver separate from the pump is convenient for the nighttime alarms and also if I want to avoid having to deal with the CGM for a little bit.  I can shove it into my purse, bury it in a desk drawer, or even walk away from it for a little while if I want.  I like the freedom from being beeped at sometimes.  It sounds counterproductive, but in the longrun, this is a bonus for me.

Trending and tracking.  Here's the point of CGMs - to track the trends of my blood sugars.  The Dex doesn't replace my meter, but instead works with it.  I test on my meter and see a result of 100 mg/dl, but with the Dex, I know I'm "100 going down," "100 going up," or "100 holding steady."  This makes it easy to go into long meetings at work without fearing a crash, and also lets me go to bed at a blood sugar of 90 mg/dl with confidence.

Pretty darn accurate.  I don't expect this thing to be right all the time.  I already have my head programmed to accept that a CGM doesn't replace finger sticks, so when things don't match up all nice-nice, I don't flip out.  Overall, though, I've found that the CGM rides pretty close to my meter.  Dex works better when I'm running a bit steadier, so it's actually a weird sort of incentive to maintain better control to retain the integrity of the sensor.  Don't ask me to mentally make sense of that - I need to take whatever motivation I can and run with it.  ;)

But it does feel sexy.  And this is the flip side to that "con" coin.  The Dexcom is sexy.  It's stuck to me to gain better control of my diabetes.  Good control helps everything from my weight to my hair to my internal organs to my smile.  Being healthy is sexy as hell.  And being confident enough to wear this machine, despite its cons and because of its pros, makes me feel stronger all the way around.  For me, after weighing all these pros and cons, the CGM is definitely worth it.

Conquering diabetes, damnit.

Readers Beware!!:  These are MY pros and cons.  I chronicle my personal experiences with diabetes here on SUM and I'm not a doctor or a CDE or a medical professional of any kind.  I have decided to use the Dexcom CGM after trialing both the Minimed and the Dexcom, but I know plenty of people who are using the Minimed CGM without issue.  For me, the Dexcom was a more comfortable fit into my life, literally and figuratively.  It's all about personal preferences, and these are mine. 

If you're thinking about trying out a CGM, I recommend trialing as many kinds as you can before making an informed decision.  Your mileage on these devices will vary, so it's important to find out what works best for YOU.  Contact your CDE and see if you can schedule a week trial session with different devices. 

If you want to share your perspectives, feel free!  I love that the online diabetes community has become a real source of information for diabetics everywhere who are looking for real information - we are the true mavens of patient experience!

December 18, 2008

Minimed Trick I Didn't Know About.

I have had this Minimed 522 for over a year now, and just yesterday I discovered an option I hadn't previously known about:  Daily Totals Screen.

My old pump had daily totals.  I would hit the utilities option, scroll down to daily totals, and I'd see a running tally of how much insulin I took in total on the previous two or three weeks.  This was a cool option I clicked on every few days so I could keep track of my total daily dosage (and it also helped me isolate the days when I was running higher, because those TDDs were higher).   

Purely by accident (because I do not read the manuals that come with any technological device - technoJOY!), I realized that my new Minimed 522 not only gives my total daily dosage, but it also gives me averages of my blood sugars.  This is AWESOME because, thanks to the One Touch UltraLink that shoots my results over to the pump and thanks to the CGM sensor lodged in my arm, I have a really good sense of how crap my blood sugars have been for the last week and a half.  

Minimed pump features I had no clue about.

(Oh how I kid.)  Actually and unfortunately, I'm not kidding at all.  Last week was a veritable ping-pong match in my body and there is concrete evidence of this terrible run in both my Dexcom receiver and my pump.  My daily insulin totals have leapt from 22 units of Humalog a day to a whopping 35 units.  (And before you start thinking, "Hey, that's not a lot of insulin," remember:  your diabetes may vary.  It's a lot for me.)  Seeing my blood sugar averages and the number of correction boluses I'm taking during the course of a week shocks my brain into lurching into action.  "Average of 189 mg/dl?  Must ... improve ... control ..."

I think this Minimed bolus/TDD/blood sugar tracking feature is very handy, and a great tool for anyone who wants to see their diabetes in a customizable snapshot.  Like I said, I now know that my numbers truly have sucked for the past week, but I'm hoping that when I take a peek at my 14 day averages next week, I'll see some improvement. 

I wonder what other secrets this pump holds. Maybe if I press a few buttons in unison and hop on one foot while wearing bunny slippers, I can unlock this cryptex to find where Siah's been hiding my wallet ...

EDIT:  Just realized I didn't specify how to find the feature, if you haven't already.  Go to Utilities, then Daily Totals, then Daily Averages. Set the number of days you want, and hit ACT. Viola! 

December 16, 2008

Diabetes Fashion Trends.

Hiding my pump behind the scarfBig sunglasses?  Tucking my pants into a pair of thigh high boots?  Ridiculous white plastic 80's earrings? 

No, no, and NOPE.

But if there's one fashion trend I'm embracing whole-heartedly, it's the scarf thing.  Scarves, pashminas ... whatever you're calling them, I love them.  Every time we're in NYC, I spend way too much time perusing the pashmina color selections offered up by the street vendors. 

Five bucks for one scarf?  Don't mind if I do! 

These handy little numbers come in a whole rainbow of colors - I have everything from midnight blue to pink to purple.  They add a splash of color to an otherwise drab ensemble, and the fabric itself is soft and flowy.  I'm frigging smitten with the things. 

And in addition to being fun and fashionable, these scarves are also my new weapon in diabetes device discretion.  One scarf, draped casually in any way that falls past my hip, can cover the bulge of the insulin pump or the Dexcom receiver.  Since I've been rotating my sites more frequently and making use of the real estate on my lower back, the tubing doesn't always reach far enough to hide the pump in my sock.  In these instances, I clip the pump to my pocket or waistline.  And the lovely scarves are awesome for keeping my devices incognito.

Even though the cold weather is chapping the hell out of my hands and making me shiver as my car warms up in the morning, I'm thankful that this chilly weather offers up plenty of opportunities to be fashionably healthy.  (And they're sort of snuggly, too, these scarves.  Almost forgot that part.)

How do you make your insulin pump or other diabetes device part of your ensemble?

December 08, 2008

Robot Warrior.

Diabetes hardware is FUN!  ;)I love a good bargain.  So when I saw the BCBG Max Azria gray sweater dress on the rack at Marshall's for $30, I had to grab it.  (Consider it my economic stimulation effort.)  The dress is a soft gray with a flattering A line cut and a nice V neck.  Clingy fabric.  Fun.

But.

This dress doesn't hide much.  And it definitely didn't hide anything diabetes-related.

Normally, I'm able to hide my diabetes hardware to the point where I feel comfortable - the sock trick lets me wear the pants I like and not have to worry about pockets, the bra trick works with most dresses, and when it's a big event, pockets can be created

But this gray dress wasn't having it.  The pump set on my outer thigh stuck out.  The tubing snaking up the side of my body and into my bra (where the pump was clipped) was completely obvious.  And the pump itself looked like a cell phone shoved in my shirt.  Not okay.  Nevermind the Dexcom sensor on my right arm that the clingy dress fabric was gathering around. 

"For crying.  Out.  Loud."  I shifted things around to see if I could get the dress to settle smoothly, but every piece of diabetes hardware was on display.  

I don't care if anyone knows I have diabetes.  I don't care at all because it's not this big deal that I want to hide from people.  I am very open about diabetes and I don't mind explaining things to strangers and friends alike.  This is evidenced by my blog, my job, my decision to network with others like me.

What bothers me is when I want to look "normal."  I want to put on a dress and not grapple with wires.  I want to grab a small clutch purse that doesn't howl with a "BEEEEEEEEEP!" when my blood sugar drops or rises.  I want to be able to have a beer at the bar without fumbling to bolus.  I felt frustrated and furious and like a diabetes robot warrior.

"But isn't the pump best for you?  And the CGM?  Isn't that best?"

I know what's best for me.  I completely understand that using a pump with the help of a CGM and all the other technology I have access to is best for me, but in that moment, I wanted it to all be invisible.  I wanted to be living with that version of diabetes that everyone on the outside thinks is so manageable.  "Oh,  you do so well with it!  You seem so well-adjusted!"  But inside I'm screaming. 

Frustration got the better of me and I replaced the pretty dress with jeans and a black shirt.  (This is the abridged version - the full version included me creating some unique curse word combinations and throwing the dress into my bag in a satisfying tangle.)  Shoved the pump into my sock and hide the CGM receiver in my purse.  Tried to forget that the pump on my thigh and on my arm wasn't natural.  Tried to remind myself that this is part of diabetes and part of trying and part of my life.  Tried to remind myself that tomorrow is another day, and it will be another day with diabetes, so rebelling against it won't do me any good.  Acknowledge, accept, and move on.

The dress is balled up in my weekend travel bag, and I think I'll leave it there for a few weeks.  Maybe I'll make another attempt.  It could look different on a different day.  I could feel differently about it.  The emotional ebb and flow of chronic disease management is ongoing.

Some days, diabetes is a better fit than on other days. 

December 01, 2008

Dexcom Discard.

Holy December - I can't believe it's the end of the year already!  Holiday chaos reigns supreme, starting with this past weekend's Thanksgiving holiday and stemming straight into New Year's.  Since I've been wearing the Dexcom pretty regularly (approximately five or six days in a row, then a day or two off), I realized how awesome it is to have that little thing attached during holidays like Thanksgiving. 

I slapped on the new sensor last week and it stayed pretty solid until last night, when the adhesive was peeling too much for me to handle.  (It gets itchy once it starts to peel, and that makes me craaaazy.)  

Dexcom sensor before I pulled it off.  All tattered.

This is the sensor after six days of changing clothes, working out, spending hours in the car, wool sweaters, multiple showers, and the general wear and tear that I put my body through in the course of a week.  The sensor is still attached, but the gauze around it isn't in good shape.  So I decided to pull the site and reapply it this afternoon.  Dexcom discard.  I'm freewheeling without the Dexcom at the moment.

The graphic on the Dexcom receiver that indicates ending a sensor run makes me laugh every time.  The little guy tosses off his sensor with reckless abandon into the garbage can.  Then it asks me, "Okay?"  Okay, let's throw the whole thing out.  (Note:  You don't throw the whole thing out.  You remove the EXPENSIVE transmitter first, then throw out the sensor housing.)

Bye bye, Dexcom sensor!

This past sensor was a bit of a needy one - it didn't want me to shower, apparently, because it kept throwing the "???" at me (meaning it's "confused" and needs a few minutes to catch up) every time I was in the shower.  It also wasn't as tolerant as usual when it came to distance, so instead of keeping it on my bedside table or on the back of the headboard, I had to tuck it under my pillow.   Maybe wearing the site on my lower back instead of my arm caused the difference in transmission - I'll have to see if it happens next time.

Watching my numbers closely for the holiday really helped out a lot.  I saw that a glass of white wine on an empty stomach actually made my blood sugar spike almost instantly.  I also saw that lemon meringue pie (de-li-cious) didn't do much after 15 minutes, but the 40 minute mark showed a real intense spike.  Insulin?  Yeah, it takes at least 35 minutes to impact my blood sugars, but knowing that made me more precise in when I bolused.  The result?  Elevated blood sugars during Thanksgiving (avg. about 195 mg/dl) but I didn't hit the wicked highs, and once I was high, I wasn't stuck there for hours.

Thanksgiving has come and gone, but I'm thankful to have another effective tool in dealing with diabetes.  Now it's time to get to the damn gym and work off that pie. 

November 25, 2008

Dexcom Sensor Video - Sort Of.

I've had several emails about how to apply the Dexcom sensor (watch the video), how big is it (like two quarters side-by-side), does it hurt (not usually), does it automatically give insulin (no - that would mean it's a pancreas), does it need to be fed or watered (no), can it fly (yes - when I throw it), do I like it (yes).

I wanted to do an akward little instructional about how to apply a new Dexcom sensor to my lower back, and with Chris's help, I think we captured most of it.  It gets a little shaky in there when we're clipping in the transmitter to the sensor housing, but you get the gist.  Hopefully.  :)

As far as placement goes, I've worn it on the back of my arm, on my abdomen, and on my lower back.  My main issue is keeping that sucker STUCK to me for the full duration.  For those of you wearing a Dexcom, where are you sticking your sensors?  Any tips on new places?  

(Please forgive me for talking so damn fast on that video.  I forget that not everyone communicates at the same foolish warp speed as me.  I need to take a breath!) 

November 20, 2008

Just Another Morning.

Wake up with a start as the alarm begins to blare,
Groggily come to and push aside my mussed-up hair.
Reach out to the nightstand and retrieve the zipper case,
Fumble with a strip and finally get the thing in place.
Lance my finger, squeeze a bit, and for five seconds wait,
Hear the beep, watch the screen, and see the "108."

Disconnect the pump with a quick and easy snap,
Grab that little plastic thing that I call a "pump cap."
Bring the Dexcom with me and connect it to the door
So I can shower, get all clean, and data will still store.

Towel dry - so careful, watching for the set and sensor,
Grab my robe and reconnect to the insulin dispenser.
Blow dry hair, drag a comb, and make attempts to dress,
Aim for outfits that conceal my pump with learned finesse.

Make my lunch and grab some snacks, minding carb-y grams -
Greek yogurt, green beans, protein bars - my morning snack grand slam.
Throw it all into my bag - I just have one more thing to add!
Toss in a tube of glucose tabs for all the lows this week I've had.

Snake the pump tube down my leg, tuck the pump inside
The trouser socks I love to wear - perfect for pump to hide.
Check the Dexcom to see for sure that I'm okay to drive,
Pet the cats, throw on my coat, and I'm out the door in five.

So much is diabetes, but it isn't my whole life.
I'm a daughter with type 1; I'm a diabetic wife.
It's in the fabric of my day, in the subconcious of my mind.
It explains so much of what I do, but I am not defined.

November 19, 2008

Need Some Adjustments.

The last few days have been nothing short of annoying - and I have the blood sugar logs to prove it.  In this past week alone, I've had six low blood sugar episodes ringing in under 50 mg/dl.  The lows are intense, sneaky, and have me fumbling with my meter, my hands, my words. 

Hypoglycemic unawareness is very, very scary to me.  It's this weird mix of being proud that I can still function at a blood sugar of 31 mg/dl, but also frightening because I'm not feeling the symptoms of a low until my body has almost crashed.  Last night, as I was getting dressed to go to Chris's film event in the city, I felt the teeniest twinge of a headache, but nothing that stopped me from doing my hair or brushing my teeth.  It wasn't until Chris asked me, nicely, if I was able to pull up HopStop on my Blackberry from the train.

My snippy response:  "Yeah.  I can, okay?"  Pause, realizing I was being enormously bitchy.  "I'm going to test.  I think I'm low."

A few seconds later, I'm looking at that officially scary number of 31 mg/dl staring back at me.  Still, no real symptoms.  I drank some juice, finished getting ready, and put on my coat and scarf.  It wasn't until I was all buttoned up and ready to go that my legs gave out and my brain went on hiatus.  It took about 30 minutes to fully recover.

Later on, during the screening, I tested at random and saw a blood sugar of 48 mg/dl.  More juice.  More nervousness, because that one came without any warning whatsoever.

I'm not sure what's been going on these past few days, but the lows have been unpredictable, yet daily.  I can't explain them with an "Oh, I over-bolused," or "I did a more intense workout than usual," or "Whoops, I forgot to eat!"  I even (TMI) took a pregnancy test to rule out any possible biscuit building.  Negative - no biscuit.  So now what?

Thank goodness for Dexcom.

My Dexcom sensors arrived via FedEx yesterday and I put one on this morning (after charging the receiver - I always forget to do that in advance).  Actually, Chris put it on for me because the sensor is on the back of my right arm today.

"I'm glad this is back on," he said, expertly pulling out the needle and attaching the black sensor to the housing on my arm.  Since I wear my sensors mostly on my arm or my lower back, Chris is the one who knows how to put them on best.  His hands move quickly and surely, talking to me as he attaches this device to my body.

"Me, too.  Yesterday sort of sucked.  The gym on Monday sucked, too."  The sensor clicked into place and he kissed me on the cheek.

"All set."

Now that I can watch the numbers trend and burn, I'm going to run a basal test for the next few afternoons, so I can see what the hell is going on with my body.  Am I suddenly more sensitive in the afternoons?  Is there something going on in the morning that is affecting my afternoon numbers?  Are the glucose gremlins on vacation?  I'm counting on my meter, the Dexcom, and a little old-fashioned freaking vigilance to help me find the source of these lows.

Either way, I'm still on this diabetes trapeze.  But at least I have a bit of a safety net now.

November 18, 2008

No More Larry Bird.

Dexcom - I need  you back!They left me alone for several months, but now the lows have returned, and they brought friends. Last night, before we left the house to go to the gym, I tested at 137 mg/dl. Knowing I'd be doing at least 30 minutes of cardio and some weights, I figured I should eat something. Grabbed a bar from the cupboard and chomped on it.

"Will that do it?"  Chris asked as he mixed up his protein shake.

"Yeah.  It has like 18 grams of carbs.  If I disconnect and eat this, I should be good."

Munch, munch.  Feeling good.  We drive off to the gym and go our separate ways - Chris to the weight room downstairs and me to the women's cardio section.  I hit the treadmill and dial up a 30 minute workout.

Music is loud - a little Muse.  My legs feel strong and my sneakers pound against the treadmill.  Strong, healthy, strong, healthy ... the words jostle around in my brain with each step.

But I start feeling a little funny at the 20 minute mark.  The music is too loud.  My headphones feel tight against my ears and my hands are numb at the very edges.  I scan the far wall of the room and the walls look a little wobbly.  My legs are a little wobbly. 

With the treadmill still running, I jump off quickly to the side and grab my meter from my gym bag.  Jump back on to the treadmill with the meter in hand, slowing down the pace so I can unzip the bag and lance my finger.

33 mg/dl.

"That sucks."  I press "Stop" on the treadmill interface and open my bottle of juice, taking eight long slugs from the plastic bottle.   My legs, which just a few minutes ago were holding me up just fine, feel like they're made of yarn.  Leaning against the railing of the treadmill, I finish the bottle.

This low feels particularly rotten.  Waves of nausea and a feeling of extreme light-headedness are coming up from my knees and cresting over my eyes.  I know I need to get downstairs and find Chris, just in case.  My legs work on autopilot, bringing me downstairs and into the weight room, where Chris is working out.

One look is all he needs.

"How low?"

"Thirty-three."

"Hmm.  Larry Bird."   He guides me by the elbow over to where I can sit down.  "Did you drink juice?"

"Yeah. I'm frustrated.  I only got 20 minutes into my workout.  And I feel like I'm all ..." Words aren't processing properly in my head.  "Mushy.  I feel mushy."

"You just need a few minutes.  You'll be okay.  Right?"

"Right."  The affirmation makes sense.  "Baby, I'm sort of tired of Larry Bird."

He smiled and we waited for the numbers to climb.

I don't know where these lows are coming from, but they are sneaky, intense little suckers that buckle me at the knees and steal the words from my mouth.  I'm waiting on my next order of Dexcom sensors to be shipped, but last night was one of those moments where I missed the Dex.  I would have at least seen the low creeping up on me a little bit.

But the wildest part is how strong I feel when I'm in that range, that 90 mg/dl range.  It's my magic number.  I feel strong, capable, almost borderline athletic.  (For those of you who know me in real life, you know how remarkable that statement really is!)  It's crazy how much just a little fluctuation in these numbers can really change how our bodies respond. 

Dex, I need you back, buddy. 

November 06, 2008

Petal By Petal.

I'm picking my priorities, petal by petal.

I'm choosing to wear this Dexcom and adhere another site to my body.  I'm choosing to have the beeps ring out and scrape against the walls of my office, letting everyone know I'm out of range somehow.  Sometimes the site doesn't bother me, sometimes it itches a little bit.  Depending on where it is resting, either on my arm or on my lower back, I sometimes see it in the mirror and am reminded of what I'm trying to accomplish.

I'm choosing to test my blood sugars and log the results regularly these days, even though keeping a log book goes against what appears to be my internal wiring.  I've always been challenged by keeping track of blood sugar numbers, even though just looking at a few days' worth of numbers really does help me isolate patterns.  I'm building a binder, and it's a pain in the arse, but I'm hopeful that tighter numbers will be the result.

I'm choosing to laugh at the things that hurt me.  When the infusion set hits a nerve as it goes in or when my CGM site bangs against the doorjam, I try to embrace my inner Yosemite Sam instead of letting the pain get to me.  Making this choice makes me hop around like a rabid bunny sometimes, and eventually gets me giggling, but it's better than feeling angry.

I'm choosing to go to the gym after work every weeknight.  I do not like the impact this has on my free time, and I don't always like the actual sweating part (oh how I hate to sweat), but I need to keep my heart healthy and my body strong ... and it helps clear my head a little bit, too.  So even though this hour and a half is something I want back at times, I know this choice is worth it.

I've chosen to limit my commitments these days, because over-extending myself leads to stress patterns that make my brain melt.  I'm stoked to do NaBloPoMo, but I've ducked out of doing NaNoWriMo this year.  I'm working at dLife and freelancing, but I'm being careful not to plan to be in fourteen different places at once.  I've decided to stay home in CT some weekends instead of making the long drive back to Rhode Island.  Peace of mind goes a very long way for me, and I'm making the choice to stay a bit more stable. 

Life gets busier and busier every time I blink, and I know it's not just me.  Everyone seems to have a side business they're cultivating, or organizations they're volunteering for, or events they're coordinating.  Life is blasting forward at a breakneck pace and we, as members of this community, have that added bonus of diabetes to manage in conjunction with everything else.  I'm trying hard not to get sucked into the stressful chaos of accomplishing everything, and instead giving a go at managing life petal by petal. 

Diabetes management, petal by petal.

October 03, 2008

Approved!!!

I have been approved!!!!!!!

YAY!!!!!!

They're covering my sensors.  I cannot believe it.  And from what I've been told, I'm one of the first on Connecticut's Oxford Health Plans to be approved for CGM use. 

Also from what I've been told, it takes an external appeal to make it happen.  So if you are fighting for CGM coverage, DO NOT GIVE UP.  Keep fighting!  Appeal every denial.  Make sure you don't miss any appeal deadlines!  It seems like insurance companies deny everything at first and only approve once you battle back.  So keep fighting, and do not give up!  (And use exclamation points!  Ahhh!  I'm so excited!!)

The tools to live well with diabetes should not just be for the people who can afford them.  Fight for your right for coverage.

October 01, 2008

Who Can Ignore The Economy?

Photo credit:  Fiction, apparently.Anyone who hasn't been storing their brain in a shoebox underneath the bed has probably realized that the economy is tanking.  People are being laid off and positions are being eliminated at companies.  Grocery money doesn't seem to buy as much now as it did even six months ago.  Gas prices, despite the fact that they've fallen a bit in the past few weeks, are still just under $4.00 a gallon. 

But these are issues that are affecting all families across the nation.  For us, diabetes care can also be affected by the crumbling economy.  My brain tends to go into panicked little pockets when I think about the economic situation.  For me, a job means more than just money - it's medical insurance.  Even now, in good health and without any outstanding medical bills, my monthly medical expenses add up.  From co-pays on items like blood pressure medication and birth control pills to the non-prescription items like prenatal vitamins and healthy food, it can get expensive. 

I was thinking about money in my budget that I consider well-spent, like my monthly membership to the gym and our grocery bill.  For some, spending $30 a month to workout and spending an inordinate amount of money on foods like fresh produce, organic products, and other fancy crap that they sell at Whole Foods and Trader Joes may seem like money that could be saved.  But when it comes to diabetes management, "control" is more than just the pump I'm using and the insulin I'm taking - it's about all these other variables, too. 

I remember (let's step into the Wayback Machine again, shall we?) test strips that could be cut in half, or into thirds, and at least the gist of a blood sugar level could be grabbed by comparing the color of the strip pad against the guide on the side of the bottle.  Granted, today's strips are more accurate, but are they really costing manufacturers $0.85 apiece to make?  (Because that's about what they charge us, as consumers.)  Diabetes supplies used to be able to go further.  Now they are indeed more accurate, but they don't go very far at all.  And keeping up with the costs of this maintenance, in addition to making attempts at important, preventative care like a CGM, is starting to make me a little nervous.  I'm finding my mind going back to the desire to wear infusion sets past their three-day shelf life and refilling reservoirs, to help extend the life of my supplies.  Ridiculous?  Yes.  But when I'm thinking about other life expenses - car payment, rent, utility bills, gas prices, and the occasional movie or night out - I find myself cutting corners where I can.

What are you guys doing to get the most bang from your diabetes buck?  Are you streeeeeetching out the life of insulin pump supplies?  Are you trying to gain insurance approval for a CGM as a way of conserving test strips?  Do you find yourself debating between paying for gas or renewing your gym membership?  The decisions are tough now, and I fear that they may be getting tougher in the future.  (And have you seen the Twitter election feed?  Regardless of who you're supporting in this election, this constant streaming commentary is pretty fascinating.)

The price of good diabetes control is high, and the cost of not trying to stay healthy is even higher.  How are you managing the cost of care?

September 25, 2008

When At First You Aren't Approved - Appeal, Appeal, Appeal.

There's a lot of buzz in the blogosphere today about insurance denials and appeals, starting with an article in the Wall Street Journal about "Pushing Back When Insurers Deny Coverage For Treatment."  Scott Strumello brought this article to my attention this morning via his comprehensive blog post about it, and Bernard sent me there again with his perspective.  And after reading everyone's take, in addition to having experienced three denials for CGM coverage from my insurance company (Oxford Health), I realize that I have gone at this problem the wrong way.

Insurance companies don't care about my future baby.  They don't care about my A1c.  Unfortunately, insurance companies are watching dollars and cents, not good sense.  A passionate letter from a patient doesn't even come close to moving an insurance company to provide coverage or overturn an appeal.  They seem to respond to "the facts" only, and I should have attacked them with facts to begin with.  Instead, I took the personal approach, which left me denied three times.  And it's partially my fault because I expect them to care, even when I know they won't.  My approach was arrogant, thinking they'd respond to actual emotion.

But this time?  No emotion at all.  This appeal was just the facts, ma'am.

I sent the Connecticut Department of Insurance a packet of information this morning, in hopes of having my Dexcom CGM system denial overturned.   I included the following:

  • Request for External Appeal form (my insurance information, healthcare provider information, detailed description of disagreement with healthcare plan)
  • The denial letter from Oxford Health Plans, stating that their decision is final
  • Proof that the service in question is a covered benefit (this was in the form of my insurance policy benefit handbook)
  • Executed medical release form
  • Photocopy of my insurance card
  • Documentation supporting my appeal, including a letter from me, my endocrinologist, and Dexcom
  • Oh, and a check for $25.  They specify that this is non-refundable. 
Insurance appeal packet - heavy.

Under the guidance of the Region Managed Care Director at Dexcom, the supporting documentation I included was very factual and devoid of almost any emotion.  My personal letter, which was written with the help of the Dexcom rep and is so stoic and so dry that it doesn't even sound close to anything I would say is supposedly an example of what "will work."  The letter from my endocrinologist cited my elevated A1c, the ADA A1c standard for pregnancy, the Factor V issue, 22 years of IDDM, and various complications I've experienced (including the cotton wool spot, high blood pressure, etc).

Dexcom also provided a packet, which included the recent NEJM study results and other studies supporting the use of CGM technology to better control diabetes.  The letter from my Dexcom rep included a demonstration of the proven benefits of CGM technology on health outcomes, and also outlined the appeal-denied-appeal-denied cycle that I've been in for the last few months.

So it's in the FedEx box now and waiting to be sent off to the Connecticut Department of Insurance.  Each item is tabbed and in the order requested by the appeal form.  It's on time, comprehensive, and fact-filled.  I hope this appeal gets my CGM approved.

The only frustrating part of this process was that I couldn't really lash out.  I couldn't tell these insurance companies what I was really thinking, which was along the lines of "WHAT THE FUCK IS WRONG WITH YOU?  CAN'T YOU SEE THAT THIS TECHNOLOGY WORKS AND I WANT A HEALTHY PREGNANCY AND WHO ARE YOU TO TELL ME I'M NOT APPROVED?!!"  (Ahem.  Sorry.)  It's infuriating to play by their rules, but I'll do whatever it takes to obtain approval.  It makes me absolutely crazy that this technology exists and it has worked for me and it's still not covered.  Don't insurance companies want people to remain healthy?  Isn't there a cost-benefit to them for acting proactively instead of reactively? What is wrong with this healthcare system?!

I'll wait patiently.  I'll hope that this fact-driven approach gets me somewhere.  And I'm very thankful for the assistance and support I've received from Dexcom, dLife, and my friends and family.

But I had to get my digs in somewhere - the memo line of the check is "ridiculous fee for appeal."  Jerkface insurance company.  They're messing with the wrong girl.

(I hope.) 

September 19, 2008

Arghhhh, Me Hearties.

The Friday Six:  September 19, 2008 edition

Holy late post, but better late than never, right, me hearties?  (Oh, this pirate crap will be the very death of me.)  Jumping right into this week's Friday Six!

1.  Yes, it's Talk Like a Pirate Day.  In celebration of this silliness, I offer you the Pirate Translator, some pirate jokes, and a Twitter avatar, courtesy of my extremely silly brother:  Kerri the pirate.

2.  The JDRF is still taking applications for the 2009 Children's Congress - but not for long!  The deadline for application is October 6, 2008, so if you and your child are interested in applying and representing the diabetes community before Congress, now is the time to apply.  Visit the JDRF website for more information.

3.  Another D-related event is the First Annual Diabetes Rockstar Cruise, brought to you by the folks at Diabetic Rockstar.  According to Sara, a SUM reader and a member of the Diabetic Rockstar crew, "The most exciting part about the cruise is that Carnival has a program called Cruising for Charity, where we will be receiving a portion of the proceeds for Fight It! our charity arm at Diabetic Rockstar.  Our funding goes to uninsured, in-need and newly diagnosed diabetics who need supplies and additional help."  Unfortunately, I won't be attending this event, but if you're interested in learning more about this cruise, taking place next May, visit the Diabetic Rockstar website

4.  And in my own personal diabetes news, I've been embroiled in the battle with Oxford Health of Connecticut for CGM coverage.  Fun.  (Sarcasm.)  I have a solid insurance representative at Dexcom who is helping me get all the paperwork together for my external appeal - yes, this is the one I have to send them a CHECK for, greedy bastards - and I'm working with my endocrinologist on a letter highlighting pre-pregnancy planning and the need for tighter diabetes control.  This is a paperwork nightmare, and now I understand why lots of people never get to this stage of the appeal, because it's so damn complicated.  BUT I am moving forward and will file this external appeal by the end of next week.  Hopefully this will overturn my previous three denials.  In any event, I'm almost positive they won't refund the $25 filing fee.  Pricks.  ;) 

5.  On the Children With Diabetes site, there's a short video about Friends For Life 2008, and you'll find a smattering of diabetes bloggers in there, including Sara, Heidi, Bennet, and me!  (And I look seeeeerious, since they caught me in the pregnancy seminar and I was all panicked ears.)  Check out the video!

6.  And I'm still woefully behind on vlogging, but I'm hoping to get a clip up here by Monday or Tuesday.  Next week is pretty nuts - I have plans for dinner in the city, I'll be at a seminar at the UN midweek, and I'm gearing up the dLife crew for our JDRF walk next weekend - but I need a little face-time.  I'm sort of short on vlog topics - any ideas from you guys?  For now, all I have is this sort of crummy quality clip from The Swell Season show on Wednesday.  I have another one, of one of their new songs, that I can post this weekend after I pull it from my KerriBerry

For now, I'm off to RI for yet ANOTHER wedding this weekend (btw, Chris and I have been married for four months as of yesterday - holy cow!) and to spend time with the family.  You guys have a great weekend!!!

September 08, 2008

CGM Study Shows This Stuff Works!!!

My insurance company still says NO to my request for approval of a continuous glucose monitoring system.  But - a ha! - a study conducted by the JDRF has given me something to print out and mail along with my third appeal.  Thanks to several dozen emails this morning directing me to the study and special thanks to Cynthia Rice, Director of New Technology Access in Washington, DC, I now have the inside scoop on why insurance companies should listen up and listen good:

Kerri:  This study quantifies the value of a continuous glucose monitoring device for people with type 1 diabetes, in particular, for adults aged 25 and over.  How did individuals over the age of 25 fare using this device?

Cynthia:  The study found patients with type 1 diabetes who used continuous glucose monitoring (CGM) devices to help manage their disease experienced significant improvements in blood sugar control. Overall, adults 25 and over lowered their A1c by .53%; were more likely to lower their A1c by 10%; and were more likely to reach target below 7.0.

Kerri:  In regards to the younger group, the kids under 15, how were their results similar or different?

Cynthia:  Children under age 15 using CGM were more likely to lower their HbA1c by at least 10% and achieve HbA1c levels below 7% compared with non-CGM users.  At the same time, the average decrease in HbA1c was not significantly different in the CGM and non-CGM groups.  Although the study was not specifically designed to assess the effect of frequency of CGM use on A1c, an initial analysis of the data suggests that patients under 15 who used CGM at least six days a week or more lowered their A1cs just as much as adults.  On average, only 50% of children under 15 who used CGM used it six days a week or more.

Kerri:  What is the assumption about the 15 - 24 age group?  Why didn't the use of a CGM make a bigger impact on their A1c values?

Cynthia: 
Fifteen to twenty-four-year-old CGM users as a group did not experience significant improvements in glucose control compared with the control group.  Although it’s clear from a preliminary analysis of the data that teenagers were the least likely group to wear the CGM near daily (30%), the study was not geared to answer this question -- however, many families with teenagers will not be terribly surprised with the result.

Kerri:  At a session at CWD in Orlando this year, Bruce Buckingham discussed how CGMs work best for people who wear them at least six days a week.  Your study appeared to confirm this statement, at least for the 25 and older group.  How does duration of use affect results?

Cynthia:  In the study, CGM use varied with age, averaging at least six days a week over the course of the trial in 83% of the patients 25 years and older, but dropping off to 30% of the 15 to 24 year olds and 50% of the 8 to 14 year olds. Although the study was not specifically designed to assess the effect of frequency of CGM use on HbA1c, an analysis presented this week at a scientific conference suggested that patients within all three age groups, including teens and young adults, who used the device at least six days a week had substantially lower HbA1c levels after six months compared with patients who used CGM less than six days a week.

Kerri:  Many people with diabetes are fighting with their insurance companies to get their CGM systems approved.  How can this study help move patients towards approval?

Cynthia:  By showing that CGM use improves glucose control, this study, published in the prestigious, peer-reviewed New England Journal of Medicine, gives justification for expanded health plan coverage of CGM.  JDRF will be briefing health plans on these results and encouraging people with type 1 diabetes and their loved ones advocate to their own health plans to cover CGM.  You can help secure coverage for CGM by clicking here.

Kerri:  And lastly, how can we, as the diabetes community, get more involved and help move research forward?

Cynthia:  When you click on this link, you can not only help secure coverage for CGM, but sign up to receive emails from JDRF on how you can advocate for federal research funding and get involved in your local community to help move research forward.  

I am Kerri and I approve this CGM.  I wish you would, too!

Thanks for your time, Cynthia!  And for more information on CGM insurance coverage, you can visit the JDRF website, sign the CGM Anti-Denial Petition, and check for more CGM updates here on SUM.

August 14, 2008

CGM Denial - Yes, Another One.

Battling for CGM coverage.Dear Liana Masone, Grievance Associate at Oxford Health,

What can I do to help you understand why my request for a continuous glucose monitor should be approved?   I've received your third and final letter, and according to your team:

"We have thoroughly considered all of the available information submitted in support of your appeal.  Based upon review of that information and the terms of your plan, a medical director with a specialty in General Surgery, continues to uphold the denial of coverage for the Dexcom sensors.  This type of continuous glucose monitoring has not been shown to provide superior health outcomes.  Therefore, an Oxford medical diretor has determined that coverage for the Dexcom sensors is Not Medically Necessary, as the term is defined in your Certificate of Coverage."

You know what's great?  The part of your website that talks about the 2008 Healthy Bonus Offers, claiming the following:  "We recognize there are ways we can help members reduce out-of-pocket health are costs.  We believe in the power of prevention: that is  by taking a little extra time to eat better, exercise and reduce stress, individuals can do a better job of staying on the path of wellness."

Is that so?  By seeking approval for the Dexcom continuous glucose monitoring device, I am trying to stop as many of the fluctuations in my blood sugar control as I can.  I am also trying to safeguard my body against hypoglycemic unawareness, because my body does not recognize the symptoms of low blood sugar with any reliability.  I am also preparing for pregnancy and making these CGM efforts for my baby and my husband.  Proactive approach, no?  You would do well to be more proactive in preventing complications, instead of being reactive and paying for them later.

According to the paperwork you sent me, I have been advised that I have exhausted my internal appeals and may now file an external appeal for CGM coverage.  You have also told me that I need to enclose a check in the amount of $25.00 made out to the Treasurer, State of Connecticut.  This check is the first item on your appeal application checklist, showing me how committed you are to making this appeal process as difficult as possible.  

I have been a type 1 diabetic for almost 22 years.  The paramedics have visited my home due to morning hypoglycemia.  My A1c is currently above 7.5% and not within the range for pre-conception, as advised by my endocrinologist at Joslin.  I do not want to experience diabetes-related complications, and I am trying to stay as healthy as I can. I will continue to fight for approval of a CGM.

In the next week, your team will receive a letter from my endocrinologist, stating her recommendation for CGM coverage.  You will also receive my current blood work results, a copy of my certificate of coverage, and yes, my check for $25.00.

I look forward to your response.  

Best,

Kerri Morrone Sparling

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 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 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!
 

June 20, 2008

Dexcom, Batman, and Gaseous Emissions.

The Friday Six:  June 20, 2008 editionWelcome to this week's edition of The Friday Six - your source for diabetes information, random websites worth checking out, and the occasional fascinating game about farts.  (Because farts are perpetually funny, despite my best intentions to grow up and act like the adult I'm supposed to be.)  Consider it "brought."

Uno.Now that my insurance appeal letter has been sent, I'm in the 30-day waiting game that Oxford Health plays.  I'm hoping that I don't need to go through a second appeal process, but I'm assuming that will be the case.  So while I wait for a response from my insurance company, I'm compiling data.  I've officially switched over to the OneTouch UltraLink, so now every time I test, I hear the subsequent "beeeep" of my pump receiving and logging the result.  When I upload my data this weekend, I'll be able to see what my numbers were and how my boluses correlated.  I'm also pulling records from when the paramedics were called in 2003 for a hypoglycemic episode and my last string of A1C results.  When the insurance company comes back with a "no," I'll have an arsenal of information to offer up.

2.  Also, the diabetes community is indeed a tight one - this was proven to me beyond a shadow of a doubt this week.  While I was away on my honeymoon, the dLife CEO met with a Dexcom representative in our area.  While they were talking, it came out that I worked for dLife.  Turns out that the Dexcom rep was someone from my diabetes past.  This representative is the woman who used to baby-sit me when I was young, when my parents went away on vacation.  Her son is a type 1 diabetic and she was the person who guided me and my parents through those first tenuous years after diagnosis.  Now, she's my Dexcom rep, and she's coming to hang out with me next week to discuss the finer points of Dexcom'ing.  Small world, eh?

3.  In decidedly non-diabetes news, I came across a link yesterday that really brought out the grown-up in me.  It's a very serious online game that deals with such mature topics as gaseous emissions and space exploration.  In fact, PuzzleFarter was one of the most serious links I've ever sent around my office.  No, it did not make me giggle like a five year old, silly.  (Hat tip to my brother, who continues to find the oddest damn things on the internet.) 

4.  Another link I've come across in the last few days has been the one where people are recreating their childhood photos.  Have you seen this?  The pictures are part of a site called ColorWars 2008 and the pictures are the "YoungMe:NowMe."  I love this one.  It makes me happy.  And this one just plain makes me laugh.

5.  Tonight we'll be trekking back to RI to hang out with friends and family, and to celebrate Batman's birthday!!  My superhero friend is ringing in her big day tomorrow and this is the first time in seven years I haven't been able to buy her the new Harry Potter book for her birthday.  Strange rite of passage.  But if you are feeling like wishing a happy birthday to the Batman friend, feel free to leave her some love in the comments section.  :)

Six!And lastly, this one last website almost caused me to end up on the floor in shock.  Prior to today, I wasn't aware that cat sharks existed.  Now I know.  And knowing is terrifying. 

Have a good weekend, Blogosphere!  :D  See you on Monday.

June 18, 2008

Dexcom Days.

Thanks to the wonders of my pre-wedding disorganization, I managed to misplace a Dexcom sensor.  Luckily, I found it in the linen closet on Monday night and slapped it on.  Just in time to see some weirdo numbers, apparently. 

Since I've been back from my honeymoon, I've had some trouble getting my numbers back under control.  Seems like all the basals and ratios I was using as "Kerri Morrone" don't seem to work for "Kerri Sparling."  ;)  Thanks to the CGM big picture, I'm trying to isolate what's causing me to go high and low at different times.  Like the morning highs. 

Part of the reason for these highs has to be my morning shower routine.  I have a tendency to wake up, test my blood sugar, disconnect my pump, and then hop into the shower.  After the shower, I need to blow-dry my hair.  Then find something to wear.  (Notice I haven't mentioned reconnecting yet. Whoops.)  Suddenly, I realize that over 35 minutes have passed and I haven't been tethered.   

This wouldn't be such a big deal were it not for the fact that my morning basal rate is cranked up to 1.0u (vs. my normal 0.4u) between the hours of 6:30 am and 10:00 am.  Therefore, I'm losing over half a unit while I'm showering and getting dressed.  This insulin-skip causes my blood sugars to leap up around 9:00 am on some days, leaving me mucking around with a high until almost 11 am.  

"Armed" with the Dexcom 7.

Armed - literally - with the Dexcom, I was able to view this phenomenon first-hand yesterday.  Holy spike.  Today, I tried bolusing 0.3u before I disconnected for my shower, then taking another 0.7u once I reconnected.  The results were much better, and I'm hoping to see even better results tomorrow.  (Has anyone else worn a Dex sensor on their arm?  How did it work for you?  Getting it on there was a hassle, I'll admit.  Thank goodness for Chris's patience!)

Last night I was able to see my overnight patterns.  Dex woke me up at 3:00 am, hollering that I was 49 mg/dl.  I didn't feel low at all, so I tested to confirm the result.  My meter claimed I was 64 mg/dl.  Fourteen point spread, but close enough that the wake-up BEEEEEP! was timed early enough for me to catch the low before I hit the trenches.  I grabbed a swig of juice and checked the graph on Dex - sure enough, I had been falling for over an hour.  

It's very enlightening to have access to these patterns.  When before I thought my mornings were decent, baesd on a test at 7 am, 9:30 am, and 11 am, I'm now seeing that there is a significant amount of fluctuation between these snapshots.  I'm curious to see what the graphs show me tomorrow, when I tweak a bit further. 

And THANK YOU to everyone who offered their insurance battle feedback.  I'm in the 30-day waiting period now, compiling data and trying to follow everyone's suggestions to present my second appeal.  Thanks to Manny for his compelling video, and to everyone who is fighting this same fight.  The technology exists, and we should all be able to access it.

June 17, 2008

First-Level Appeal Letter re: Dexcom Denial.

Hear me.I received a letter today from Oxford Health Plans, denying my request for CGM coverage.  "Our Medical Director has determined that the request is:  Denied - Not Medically Necessary."

My First-Level Appeal letter is below.  This is the first round of a potentially long battle, but I'll see it through as far as I can, I promise.  A price tag on my health?  I don't think so.  Here's hoping they listen.

"June 17, 2008

Clinical Appeals Department
c/o Oxford Health Plans, Inc.
PO Box 7078
Bridgeport, CT  06601-7078

To Whom It May Concern:

On September 11, 1986, I was denied a normal childhood when I was diagnosed with type 1 diabetes.  My parents were taught to measure my food, test my blood sugar, and inject insulin into my body.  We were taught about diabetes complications and how they may end my life.  We were taught to plan for the worst and hope for the best.  This was my mortality, handed to me when I was just a child.

On January 27, 2003, I was denied the ability to control my blood sugars with insulin injections alone.  My medical team determined that my diabetes would be best controlled with an insulin pump instead of multiple daily injections.  Thanks to my hard-working medical team and my personal dedication to good health, I started using an insulin pump.  My A1Cs have been lowered and my risk of diabetes-related complications lessened, thanks to the benefit of this technology.

On April 15, 2006, I was denied the symptoms of a low blood sugar while I was at the movies.  Thanks to my years of hard work and my desire to keep my diabetes as well-controlled as possible, my body was less sensitive to the symptoms of low blood sugars.  Therefore, a blood sugar of 27 mg/dl snuck up on me without warning, leaving me moments from a diabetic coma.   Currently, I experience severe hypoglycemic unawareness, leaving my body at risk for potentially lethal, undetected low blood sugars.

On May 18, 2008, I was denied a wedding without diabetes.  Surrounded by friends and family, and with my husband-to-be standing proudly at the front of the church, I walked down the aisle.  My mother cried, later admitting she always feared I would not see this day in good health.  My blood sugar plummeted, without warning, before the first dance as a result of my excitement.  I did not feel the symptoms.  I spent my first dance with my husband clinging to his arm, trying to focus and waiting for the glucose tabs I had just eaten to raise my blood sugar.

On June 13, 2008, I was denied health insurance coverage for a continuous glucose monitor by Oxford Health Plans. 

I am twenty-nine years old and have spent more than two decades living with type 1 diabetes.  My wedding was barely a month ago.  I am so excited to start a family with my loving husband.  I will not be denied the chance to have a healthy pregnancy.  I will not let my mother be denied a good night’s sleep because she’s worried her daughter will have an undetected hypoglycemic episode in the middle of the night.  I will not let my husband be denied a healthy wife. 

A Dexcom continuous glucose monitoring system receiver costs $800. The sensors cost $240.00 for a pack of four.  Over the course of a year’s non-daily use, the Dexcom system will cost approximately $1,800.00.   

Compare this cost to that of laser surgery to treat diabetic retinopathy.  Or the cost for kidney dialysis or transplant.  Or the cost of daily medications to treat high blood pressure, cholesterol elevation, or kidney disease.  Or the cost of an amputation, as well as any attendant costs for rehabilitation and lifestyle adjustment.   Please be advised that keeping me healthy now will save your company from greater expense later; preventative measures taken at the present time will mitigate the overall financial loss your company would otherwise incur in the future. 

Denying my claim to protect your company’s bottom line is to deny my chance for a long and healthy life. You have marked my claim as 'not medically necessary.'  You have boldly put a price tag on my health. 

Your denial may cost me my life.  I urge you to reconsider your decision.

Sincerely,
Kerri Morrone Sparling"

June 16, 2008

You Wouldn't Like Me When I'm Low.

You wouldn't like me when I'm low.  Or maybe you would.

While we waited for the traffic to disperse this past Friday night, we went to see The Incredible Hulk.

So Ed Norton (who I love ... loved him in Fight Club and The Illusionist) plays The Hulk and spends the better part of the beginning of the movie trying to keep his rage under control because ... you know ... you wouldn't like him when he's angry.  He wears a heart rate monitor to help keep him safe and controlled.  It's one of those wristwatch bits that beeps as his heart rate climbs and wails insistently when his numbers are too high.

"Dude,"  I lean in to Chris.  "I didn't know the Hulk wore a CGM!"

He whispered back, "I know!  I thought the same thing!"

The movie continued, and Ed Norton finally loses it and becomes The Hulk.  After his episode is over, he's shivering, weak, and holding his tattered pants close to his body.  He looks completely spent and in need of a solid nap.  Much like how I feel after a wicked low blood sugar.

"Only minus the tattered pants part," I explained to Chris after the movie.  

It's strange how movies depict diabetes.  I remember watching Panic Room and seeing the little girl experience a hypoglycemic episode.  She was blue-lipped and sweaty, lying helplessly on the floor while her mother scrambled for sugar.  But I didn't see myself in this Panic Room character, even though she was written as a diabetic and her symptoms were "appropriate." 

Instead, I empathized more with The Hulk as he closely monitored his heart rate, those numbers taking precedence over all other things, their fluctuations determining many of his actions.  And I felt a pang of recognition when he came to after an "episode," bewildered and fragile and not knowing quite what happened. There are strange bits of empathy and recognition found in the most unlikely of places.

I bet if The Hulk needed a CGM, insurance companies wouldn't deny him.

"Hulk smash ... insurance companies!"

June 13, 2008

The Long Road Towards Insurance Coverage.

Pay to keep me healthy?  Or pay when I am sick?  Your call.(This is a loooong post.  And contains many terms that I just learned today.) 

Dexcom and I are looking forward to being reunited (out of sensors at the moment), but before we can do our Dex-y dance again, I need to get this stuff covered by my insurance plan.  My contact at Dexcom put me in touch with their insurance management team, and they've been working hard to get the proverbial ball rolling.

I spoke with one of the reps earlier in the week.  She was very hopeful about insurance coverage, telling me she'd start processing the claim through Oxford Health (they are my insurance provider) and would touch base with me with the good news.  I laughed.

"Good news?  Let's be honest.  There's rarely ever any good news when it comes to insurance ... anything.  So let's assume they'll reject it, and we'll create a battle plan from there."

She laughed.

"Right.  A battle plan!  I'll contact you as soon as I have any new information."

True to their word, an email came in from Dexcom yesterday. 

"Hi Kerri,
We have not had any luck in getting other patients through Oxford. We also tried to go through a distributor without any luck. So, we are going to ask Oxford for a predetermination or "one-off" approval. We may need to come back to you for more information should they request it. We will keep pushing on our end.

Your plan does provide for DME devices (the DexCom products are a DME benefit). However, you have a $1,000 deductible, with $0 met to date. After that, your coverage is at 70%.

Thanks,

(Dexcom Guy)"

Arghh - directed at insurance companies, not at Dexcom.  $1,000 deductible, and even after that's met, a 70% coverage rate?  Blast, that's pricey.  And am I ignorant because I have never heard of a DME before?  I asked my boss and she explained that DME stands for "durable medical equipment."  I looked up these kinds of requests on the Oxford site and found the following:
 
"Durable medical equipment (DME)* No charge - Deductible and coinsurance"
 
Uh oh.  What's that asterisk all about? 
 
"These services require Oxford precertification. You must call us at 1-800-201-3080 at least 14 days in advance of request. Mental health and substance abuse services can be precertified through the Oxford Behavioral Health Department by calling 1-800-201-6991."
 
Okay, so that notation means I need Oxford precertification.  What the heck is that?
 
Before I could research too much into it, another email came in from the folks at Dexcom.  It was from one of the reimbursement managers and she carefully outlined what actions she had taken with my insurance company.  She spoke with the benefits department at Oxford, the Medical Management Department, and letme know what the next steps are.  I really appreciated her thoroughness and at least had a timeline to attach my frustrations to.  
 
At this moment, my request for precertification is in play with Oxford Health, despite the fact that the Oxford rep told my Dexcom rep that the sensor codes are not covered by Oxford insurance.  These are the hoops we must jump through?  Blast again.  The policy and rationale of Oxford's "nah, we don't want to" is as follows:
 
"Due to insufficient clinical evidence to support medical efficacy, the rental and/or purchase of continuous glucose monitoring systems for long-term use in the treatment of diabetes mellitus will not be reimbursed by Oxford.  This service and/or device is not proven to be clinically effective and, therefore, is not considered to be medically necessary."
 
Not effective?  Didn't this thing save me from losing it at the bank?  And didn't Chris say to me this week that he's glad I'm pushing for insurance coverage because he sleeps better knowing I'm protected on the overnights?  And aren't these questions rhetorical?  (Yes.)
 
Looks like the deck is a bit stacked against me at the moment.  But I have the attentive staff at Dexcom on the case.  And I also have a team of terrific doctors, both at Joslin and here in CT, that are going to go to bat for me on this.  I'm currently drafting up a letter of medical necessity to be sent to my insurance carrier.  And I'm also not giving up on this.  Chris and I are a married couple now, and starting a family in the next year or two is in the cards.  I experience severe low blood sugars at times and have a tendency to run high when under duress (yay), so the idea of a CGM to help keep me and my future child safe while he or she incubates inside of me sounds like a necessary safety measure for both me and my baby-to-be.  
 
So ... I'm on the long road towards CGM insurance coverage.  I will show these insurance reps that diabetics have every right to the tools available to manage their disease.  Cover me now, and I'll achieve tighter control.  My blood sugars will be more closely monitored and managed.  The risk of debilitating diabetes complications can be reduced.  My life may be improved, just as an insulin pump improved my control.  I may live longer, for crying out loud.  That's a plus, right?  I tend to think so, and I'd venture to say that my family agrees.
 
I know insurance carriers don't care if I'm happy.  They don't care about my children or my husband or my mother.  They care about their bottom line.  Well how about this:  Make the investment in me now and I will be healthier. 
 
It costs less to manage diabetes than it does to manage diabetes complications.

April 23, 2008

Lunchtime Lows.

I'm standing at the counter at the bank and I hear my cell phone buzzing.  Then I hear the Dexcom wailing out its BEEEEEEEP.  My pump starts to buzz from inside my bra (wearing a dress today).  Every bit of technology I have is exploding all at once and I'm just trying to make a damn deposit.

"Miss, I just need your account number."

"Account number, sure.  I can get that for you."  BEEEEEEEEP again.  Why is it beeping again?  It should only beep once when I'm high.  My goodness, I'm awfully warm, despite standing underneath the bank air conditioning unit.

I stick my hand into my bag and forage about.  My fingertips feel like they're trapped in cotton balls and I can't quite get a good handle on my wallet.  Instead, I grab the Dex, which is BEEEEEPing again, and press a button.

Oh shit, LOW.  Below 40 mg/dl.  I press the down button and see "39 mg/dl" next to the blood sugar graph, which now looks like the Cliffs of Insanity from The Princess Bride.

"Here is my license.  Can you pull my account numbers by looking up my name, please?  I'm diabetic and having a little low blood sugar at the moment and I need to drink this juice."  I hand the teller my license and raise up the bottle of juice with my other hand, like one of the Price is Right models.

"No problem.  I'll get your account numbers.  Do you want to have a seat?"

"No, no thanks."  I drain the bottle between words.  "I'm good.  I just need to focus a bit and let my blood sugar come up."

He typed some numbers in on his keyboard and passed my receipt through the bank printer.  "This isn't some elaborate plan to rob the bank, is it?"

I laughed.  Just drinking the juice alleviated the low-panic enough for me to act like a normal (slightly sweaty) person.  "I'm not robbing the bank.  But I may take one of those free lollipops, if that's okay."

He hands me my receipt, along with three purple lollipops.  "Here you go.  Why don't you wait a few minutes over there," he gestures towards the bank reception area, "for your blood sugar to come up?  I don't want you to drive yet."

SUM lollipops from the bank."Okay.  Thanks for your help."

And I teeter carefully on my heels (far too high for such a low blood sugar) over to one of the plush, blue chairs.  Sinking into the chair and waiting for the juice to do its thing, I unwrapped one of the lollipops.  My feet didn't quite reach the floor, as I was sitting so far back in the chair.  But I was starting to feel better.

People came in and out of the bank over the next ten minutes while I rested, looking over and most likely wondering what that grown woman was doing there, face flushed, swinging her feet, and sucking happily on a lollipop. 

April 22, 2008

Beeeeeeeeep!

Image credit to Maplenet.netWell hello - I'm rather grumpy today.

I had a moment of cyborgy-ness yesterday, when I was dressed for bed at the end of the evening, yoga pants and a sports bra, and I realized that my pants were sort of falling down, thanks to all of the gadgets hooked to my waistband.  The pump and the Dexcom, separately, are not heavy items, but together they are a bit weighty.  Even though I welcome the protection from lows and highs that Dex is offering, I felt a bit unattractive and robotic.  And my blood sugars have been troubling for the past few days, causing the Dex to sing at me with that loud, loud, loud BEEEEEEEEP!

(Note to readers:  If this post is making you feel like you want to chime in about how being sexy/attractive is far less important than good diabetes control, now is not the time.  I understand how important diabetes control is, and I work hard to achieve a relatively respectable rein on things.  But for that moment last night, I wanted to feel like a girl, not a robot.  I am entitled to these desires.  I am a real human being, not a spokesperson of any kind.  :: steps off soapbox, though laughing at the literal illustration of the bar of soap on the box over there on the right.  Hee hee. ::)

Dex and I are linked back up again this week, only this time the sensor is on my right thigh.  (My pump infusion set is on my left.  I'm sporting diabetes saddlebags this week.)  I'm hoping that having the sensor in a place that doesn't bend, flex, and deal with waistbands will help keep in place more than four days.  The numbers have been pretty precise all day long, except I've seen my first "???" indicators popping up.  According to the user manual, this means that the sensor may be disrupted by my clothes rubbing against the sensor face.  With the site on my thigh and sporting jeans today, that may be the case.  It seems to help if I keep the Dexcom clipped to my pocket, closer to the sensor itself.  However, numbers are still relatively accurate.  My faith is still strong in this product.

But the annoying bit I'm noticing the most, and which is sending me into a bit of grumpiness, is the beeeeeeping.  The "Above 180 mg/dl BEEEEEEEEP" that permeates my office.  It's not the fault of the product but more of an alarm that announces my body's failures.  It bounces off the wall, ricochets into my ears, and shaves off a bit of my ego.   "BEEEEEEP - Kerri, you're high.  Your diabetes is uncontrolled at the moment - HEY EVERYBODY!  She's high!"

Over the past two weeks, stress levels have once again crept up, and I'm finding myself a bit looped out at times.  The wedding is closer, finances are spoken for before they arrive, work is extremely busy, and personal projects are ramping up, thus grabbing and needing more of my attention. 

Most often, I'm very upbeat, quick-witted, and pretty damn smiley.  But today - meh.  I'm grumpy and frustrated with stress, the snowglobe of ideas in my mind, and that damn BEEEEEEEEEP.  I become disheartened when my efforts at good diabetes control - hell, good LIFE control - are thwarted by these unseen little factors, like stress, or maybe weak insulin, or the pile of wedding things that still need to be wrangled ... it's a bit much today. 

I would love a personal assistant.  Or, better still, a vacation.  Instead, I have a headache.  And BEEEEEEEEEP

April 17, 2008

Unsticky.

Apparently, the Dexcom sensor has improved to the point where it can be worn for seven days and is now waterproof.  So YAY for being able to use one sensor for more than three days and YAY for not needing to use those insanely painful shower patches when bathing.

I have found one drawback to the Dexcom so far, though.  

Another Dexcom site starting to peel away.  Damnit.
 Day Four:  The Unsticky.

It's coming undone.  Over the course of a normal day, I shower once in the morning before work and once after my hour at the gym.  Is it my shower that causing this thing to come loose?  Is it my workout routine?  Is it my clothes?  Am I tugging on it at night without meaning to?

Whatever the case, I'm fearful that this sensor will also come loose before the seven day mark.  Last time, I taped it down with medical tape and made quick use of a bandaid at work, but there has to be a better way.  I'm prepping the site with sticky IV prep before insertion and I'm doing my best to install the sensor in a section of my abdomen that doesn't contact the waistband of my pants, yet it's still starting to peel away.

What do you guys do to keep your sensors stuck?  How about a pump site that comes loose? I'm thinking about installing the next sensor on my hip or thigh to see if that helps keep things more securely attached.

In any event, I can't be bothered too much.  It doesn't hurt and it's giving me solid numbers.  All I need now is some super glue

April 16, 2008

Dexcom's Laboratory.

The Dexcom has added a whole new dimension to my existence:  Muttering.

Kerri:   (muttering, of course)  Okay, so you say 176 mg/dl.  My meter says 150 mg/dl.  But you say I'm rising. 

Dex:  (silence)

Kerri:  (checking her pump for any insulin on board)  Hmm.  I don't want to end up high.  I can see that the numbers are climbing on the Dex and ...

Dex:  (like a lion roaring through a megaphone, or maybe a jet plane taking off inside an empty pool)  BEEEEEEEEP.  High - above 180 mg/dl.

Kerri:  Ahhhh!  

Kerri's Office Mates:  Kerri, are you beeping?

dLife CEO:  (from office)  Is that you or me?

Kerri:  Yeah, it's me.

Dex:  Beeeeeeeeeeeep!

Kerri:  (muttering again) I don't want to be high.  Dex says I'm high.  I should take a little bolus to correct this.

Pump:  Boop beep boop.

Dex:  Beeeeeeeep!

dLife CEO:  (from office)  Did you bolus?

Kerri:  Ahhhhhhhh!

Working with the Dexcom has really enlightened me as to how quickly my blood sugars skyrocket during times of stress.  It has also shown me that my overnights are so finely-tuned that my numbers are flat-lined throughout the night.  (That makes me very, very happy.)  But Dex is also making me a little more OCD than usual, and I'm feeling oft-compelled to correct blood sugars when I should instead let them ride and settle neatly on their own.  I'm quickly developing a nasty habit of pinch bolusing for EVERYTHING, which is causing some tricky little lows. 

I need to learn to be patient with this new technology.  I also need to remember that the Dexcom updates much faster than my insulin works, so I can't be chasing every Dex result with the boop of a bolus.  Sometimes I just need to let my insulin work and learn to better manage the emotional blow of an upward cresting graph.   

(Unrelated:  I saw llamas today on my lunch break.  They did not have diabetes, but they did have wonderful personalities.)   

April 10, 2008

Straight Dex'ing It.

It's official:  I'm applying to have my Dexcom 7 covered by insurance.  I'm choosing to make the Dex part of my management plan.  Over the next week or so, I'll be battling my insurance company to cover my sensors.  Yes, I'm taking the leap.  I don't plan to wear it every single day, but I know I will be sporting it several times a month, more so when I'm closer to planning a pregnancy.

"How's the accuracy?"

It's as accurate as can be expected for new technology - and by accurate, I mean that the Dex7 says I'm 143 mg/dl, my meter says I'm 154 mg/dl.  Those it's higher than I'd like to be (more on that in a minute), those numbers are close enough for me to trust both the trends and the snapshots of Dex.  If I'm going to bother wearing a second device, I want it to be worth it.  And for the last four days, these numbers have been close to one another, so long as my blood sugars are under 260 mg/dl.  Above 260 mg/dl and the gap starts to widen, but I'm not shocked by that considering how my MiniLink trial played out.

"How about comfort?  Is it comfortable to wear?"

I have to be completely honest - comfort is the other deal-breaker for me.  My criteria for a CGM is a. be accurate and b. be comfortable.  Accuracy is reasonable (as stated above).  The only other CGM I've used is the MiniLink, but the Dexcom is far more comfortable.  And I know exactly why.  The MiniLink sensor is not completely adhered to the skin, leaving the "shell" part flopping about a bit.  Even when I taped it down, the sensor still had mobility and the needle shrugged around uncomfortably in my skin.  It made the site ache something awful, regardless of whether I wore it on my arm, my thigh, or my abdomen.  The benefit to the Dexcom sensor is that it's all one piece that is backed by an adhesive, leaving every part of the sensor stuck to my skin and holding steady. Therefore, it didn't hurt me at all and once it was installed, it didn't feel much different than a pump infusion set (only it's slightly bigger). 

I realized this crucial difference in the sensors this afternoon.  For the last three days, my Dex sensor has been securely stuck to me.  But I shower every morning before work and go to the gym every night (then shower again), and the combination of shower, intense workouts, and snug clothing rubbed the sensor a bit the wrong way.  Even though it's meant to last for seven days, it peeled away from my abdomen and came loose a few minutes ago.  Blast.  And for the last 12 hours, it's been floppy and felt sore, leading me to believe that it's the steady adhesive of the Dex that makes it way more comfortable than the MiniLink.  It makes sense - who wants a wire scraping haphazardly around in their skin for hours on end?  Not me. I want that wire to sit still and behave itself.

The Dexcom 7 sensor after it leapt from my body.

"I heard software comes with this one?" 

I loaded up the Dexcom software this morning for the first time.  It's remedial-looking (much like the OneTouch software I have at home), but it serves its purpose of downloading and organizing blood glucose results.  This is a definite upgrade from the old Dexcom software, which was nonexistent. ;) And thanks to my ridiculously awful blood sugars all week long, I've been able to really see all the pretty colors that the Dex software has to offer. 

Screenshot of Dexcom software

"So what now?"

Now I'll make use of the sensors I've received (taking a few days off and reinstalling another one on Sunday morning, post-bachelorette party) and move forward on the insurance verification and approval.  I'll be sure to document my progress with the insurance approval, because I know that's a concern for many people considering a CGM.   

"You mentioned a rough week of numbers.  What's going on?"

Dude, I have no idea.  My numbers have been grossly high all week long, highs in the "Hey, I'm a newly diagnosed diabetic" range like 409 mg/dl, 363 mg/dl, and my favorite, the stubborn 212 mg/dl that visits me without calling first.  I'm changing out my infusion set tonight after work, in hopes that a dodgy set may have been the problem.  Or maybe it was a busted bottle of insulin.  Either way, these blood sugars are reflecting a botched set, or raggedy old insulin, or work/wedding stress, or just plain Blech.  Or maybe all of these things.  One way or the other, I know I need to get things under control FAST because I feel like garbage.  My days with Dex showed me just how bouncy my numbers have been. 

Time to buckle down and focus on what matters most - not deadlines or scheduling or planning, but getting these numbers back under control.  It all starts here.

April 08, 2008

Dexcom Seven: The Warrior Returns.

I made the mistake of saying the following to Chris the other morning:

"You know, I haven't had a low in like two weeks!"

The next morning, the alarm went off and my eyes slowly opened, as though there were weights attached to each lash.  Brushing my hand against my forehead to wipe off the sweat, I reached for my meter and loaded in a strip.  For some reason, the lancet wasn't pricking my finger.  Shunk.  Shunk.  Shunk.  Chris stirred beside me. 

"It won't bleed."  Said as though the blood wasn't mine, the finger someone else's.

Finally, a ruby red spot leapt up from my fingertip.  Five seconds later, 48 mg/dl winked at me from the meter.  I drained the small bottle of juice on my bedside table and snuggled back underneath the comforter, waiting for my body to catch up.

I had two more lows that day, one that left me shaking at my desk at work and another that had me stumbling on the treadmill at the gym.  The next day, I hit a sticky high of 409 mg/dl after a site change, the sweaters knitting up in my mouth and lethargy wrapped around every movement.

The DexSignal

So when the Dexcom Seven arrived at my office, courtesy of the reps out in California, I didn't think twice about suiting up for another round as the Dexcom Warrior.  I installed my first Seven sensor on Sunday night.

I know what you're thinking:  "You had a rough experience with the MiniLink - why are you doing this again?"  

Why?  Because I found the Dexcom to be a superior CGM product.  Minimed makes my pump and therefore has my appreciation, but their CGM unit is sub-par.  Aside from the flopping sensors and the painful insertions, the darn thing just wasn't right.  I know CGMs aren't supposed to be a substitution for manual blood glucose testing, but I had little confidence in even the trends offered by the MiniLink - and I was very frustrated by the errors that were cropping up.

The Dexcom, however, had a more reliable trending ratio and the actual results correlated tighter with my meter.  I'm not thrilled about using a second device (the receiver being its own entire hub device), but if I'm going to make use of a CGM on occasion, I want things to be as "right" as possible.  Like right now:  Dex says I'm 146 mg/dl.  Meter says I'm 137 mg/dl.  It also says I'm on the rise, which is true - I was 92 mg/dl an hour ago.  

So I'm spending this week with the Dexcom Seven, making it part of my work day, my workouts, and my wedding stress.  With wedding planning coming to a wild and all-consuming crescendo, I'm hoping Dex can help me stay more tightly controlled.  Because, between you and I (and the entire internet), I'm having trouble keeping my numbers steady these days.  Diabetes is rearing its head and I, for one, am not feeling very armed for battle.  Hopefully I can sharpen my Dexcom skills and have it as my secret weapon. 

February 18, 2008

Assessing the MiniLink.

No More Medtronic MiniLink for me these days.The MiniLink trial has ended.  And I have plenty to say. 

The Good:  First off, Medtronic's level of customer service was unprecedented, which isn't unique for this CGM experience, but for my past four+ years with Medtronic on the whole.  My representative was attentive and drove all the way frickin' down to me from Boston, spending several hours explaining the ins and outs of this technology.  After I was hooked up, a local rep contacted me and offered to walk me through any issues.  Also, my contacts at Joslin were quick to touch base and see if I needed a hand with the insurance hurdles.  Overall, everyone on Medtronic's team made navigating this system as easy as they could.

The MiniLink CGM is smaller than it's predecessor and that shows me the kind of technological progression I need to see in order to become vested in a product.  The shape of the transmitter is rounded and aerodynamic, helping it to lie flat against the skin and remain pretty incognito.  And I didn't need to sport one of those wacky shower patched when I bathed, which was a definite plus.

On the second through the fifth days of a sensor, the numbers were within 50 points of my meter and I saw trends in my afternoons that I had no clue were happening.  Thanks to the CGM technology, I was able to isolate a basal issue and tweak accordingly.  And I loved - LOVED - looking at the graphs and seeing where I had pockets of lows or highs.  Useful information, when it was providing the right data.  

The Bad: 
The CGM has the best intentions, but only when calibrated in ideal circumstances, and my schedule lately hasn't provided many moments of plateau.  The results aren't too shabby when I'm calibrating at the right times, but it missed three bad lows on my overnights - 43, 39, and 34 mg/dl, respectively.  (And when alarms did go off, I couldn't hear them with the pump against my waist and buried underneath the winter blankets.  With the alarm set at 70 mg/dl and not being on the sensor's first day, it should not have missed three of these.)  That's the whole point of the damn thing - to protect me.  It did respond more accurately when I was edging towards a high, which was helpful.
 
But wearing it?  I'm not sure how you do it and not go nuts.  I'm going to work and going to the gym every week day and the sensor did not make dressing for either event very easy.  When I wore it on my arm, I bonked it against door frames and snagged it on sweatshirts.  When I wore it on my thigh, it ached against my muscle tissue.  And the three times I wore it on my abdomen, it was disagreeable because I do not like wearing anything device-esque on my stomach and it felt intrusive to me.   The transmitter doesn't lay flat and seems flop around unless I tape it down with an inordinate amount of medical tape.  And when I didn't have it taped down solidly, it shifted around a bit and tugged the needle out of place, which I found to be very painful.  I do not want any more pain than is necessary, and bloody, botched sites do not bring me any peace.

The Honest: 
  Unfortunately, MiniLink and I did not see eye to eye this round.  I'm not comfortable making any efforts to have my insurance company pay for something that I found to be frustrating, and I definitely am not in a position to pay out-of-pocket just to have one to play with.  I'm not comfortable using the MiniLink for my own diabetes management, but I don't plan on discouraging anyone from using it in theirs.   
 
BUT - and this is huge - I am an adult.  I can test my own blood sugar, dose my own insulin, and communicate how I feel.  I can completely see how a CGM can help a parent of a diabetic child feel like they have a "translator" for their kid's diabetes.  I've rec'd several emails from people on the Children With Diabetes board who asked me about the MiniLink and I recommended it, and other CGMs, to them for that reason.  I can also see how people who have more time to commit to learning this device and spending several weeks making it work in their lifestyle could benefit from the technology.  Maybe now isn't the right time for me to be wrangling in a device that requires plenty of fine-tuning and patience.  But if not now, when?

I hope to retry the Dexcom 7 and see if there have been improvements made from the 3 series I tried last July.  I know that different companies keep coming out with new versions of the continuous glucose monitoring systems, but I just want one that I can rely on, to a certain extent.  Bells and whistles and colors and shapes don't mean as much to me as accurate numbers. 

February 04, 2008

The Saddle.

Continuous glucose monitors are expensive to purchase and maintain, with costs approximating around $900 for the device and $40 for the individual sensors.  Insurance coverage for this technology is tough to wrangle, even though there have been a few break-throughs in the last month or so. 

Bottom line:  This stuff is expensive.

I have a box of MiniLink sensors in my fridge that I am able to trial at no cost to me, and I have access to several Minimed representatives that have been very helpful in getting me rolling.  I owe it to myself to give this thing another try, aiming to be more levelheaded and patient as I adjust to this technology.

Other Bottom Line:  I'm a fool not to take advantage of every opportunity I am given. 

Therefore, after a weekend home in Rhode Island spending time with friends and family and generally chilling out, I came back to work today feeling calm, collected, and not ready to give up. I'm not the giving-up type.

This afternoon, during my lunch break and at a level of low stress, I installed another MiniLink sensor.  I'm going to try this again.

Admittedly, I have a short fuse.  Things piss me off pretty quickly and are often thrown as a result.  I'm a little ashamed of my hot temper and I have trouble controlling it sometimes.  So when the CGM was pinging away, beeping and hollering and throwing inaccurate results, my fuse was lit and my temper flared.  My numbers weren't steady as a result and I ended up contributing to the problem.

I was frustrated with this thing.  Chris and I talked about it, weighing pros and cons and figuring out ways to integrate this device into my already busy agenda.  Wearing a CGM may not be the best decision for me at this point in my life, but I need to give this a solid and fair trial.  Instead of letting myself fly off the handle because the results aren't completely accurate or the device isn't completely comfortable, I need to just take what I can from this experience.   

I'm going to wear this sensor and see what I can learn from it.  I'm not expecting precision.  I won't let it replace my blood sugar tests or dictate my insulin doses.  I'll simply wear the damn thing and see whatYes, it's My Little MiniLink ... Pony.  happens.  I'll download the numbers from my pump and see what kinds of trends I can isolate from the data. And I'll continue to give you guys an honest assessment of how I feel about this technology.

Either way, I am very lucky to have access to this kind of device and this kind of outlet for discussion.  I need to make the most of it and hopefully learn something about it. 

In the process, I'm hoping to learn a little about me, too.

January 28, 2008

Making Decisions.

Your feedback has been tremendously helpful on this CGM front.  Thank you SO MUCH for your help.  I've had a lot of moments lately when I'm not sure what to do next, because things are spinning so quickly.  Must write that article, must finish that edit, must call that vendor, must try the newest and latest diabetes technologies, must, must, must.  Oooh, and don't forget to sleep.

There's an art to time management, one that I haven't even begun to figure out yet.   I envied people who are able to take on several tasks and get them all done without compromising their sanity.  In my own busy brain, I figured that I just wasn't trying hard enough.  I needed to try harder, and then the work tasks would be done, the body would be well-managed, and diabetes wouldn't be sending up distress flares.

But I am trying hard.  I need to learn to be more forgiving of my own short-comings.  I need to live at peace with this disease.  While it wants attention at every moment of every day, and has demanding that attention for the last twenty-one years of my life, I can't always give it what it wants.  I have a LIFE going on here, one that isn't even close to dictated by diabetes.  

"Wait, wait.  What about your job?  Your job is about diabetes!"

But it isn't.  While I'm writing and editing articles about diabetes, my job isn't about focusing on my own diabetes.   It's about raising awareness of diabetes as a whole, providing information to the public about the disease, and enjoying the inspirational vision of this company.  Diabetes-related or not, this job comes with awesome co-workers, stressful deadlines, and a full range of chaotic fun. I enjoy my job.

"Okay, then the blog.  Your diabetes blog?  Doesn't that become suffocating?"

Yes and no, to be honest.  I like blogging, and doing it for almost three years now has been awesome.  But this blog isn't about diabetes so much as my life with diabetes.  LIFE.  I know I'm in a tough place, diabetes-wise, when I see that my blog posts are focused solely on diabetes-related matters and I'm all questions and stress.  I know I'm light-hearted and silly when the stupid cat makes an appearance.  This blog, though it deals with diabetes issues, is free therapy.  It makes me feel better to write it.  And I like going back to read how I've healed.

"... so your life isn't about diabetes?"

No, it isn't.  It's about ... me.  Diabetes is just a bit player on a big stage.  And for the next few weeks, I have a wedding I want to focus on.  My mom called me about my wedding shower today and I'm completely excited and nervous and thrillled.   I have my awesome friends who are just a state away and I can't wait to see them this weekend.  I have work to do here at dLife, working on content for the new shows and having some silly moments with co-workers.  I'll always have this disease to manage, but sometimes it's easier to manage from a distance, rather than with my nose pressed against the glass. 

I'm going to take a few more days off from the CGM.  I'll call Mr. Minimed in the next day or two and tell him my plan.  And I'll wait until I'm feeling less rumpled and more at ease with other aspects of my life before throwing in the frustration of a new, albeit potentially beneficial, device. Giant, Happy Chili Pepper.  Duh.

I'm making the decision to relax, have some laughs, and loosen up a bit.  It'll all get done ... no need for the furrowed brow.  I'm not myself when I'm being so damn serious.  It's against my nature.

(Notices the huge chili pepper posterboard cut-out taped to my office wall.) 

Totally against my nature.   

January 25, 2008

On The Cusp.

I have a confession to make:  I have been having a hard time making peace with the CGM.  

There's been a lot going on in my little corner of the internet.  I've been very busy with dLife items, personal freelance work, and some exciting side-projects.  But aside from the worky bits, there are the general "life bits" that everyone contends with, from housework to financial obligations to being an equal and active member of my new little family (even if the family is only a fiance and a handful of grumpy cats at the moment).  Now add some diabetes management to the mix, with a dash of wedding planning. 

These days,  my life requires a lot of work, and there are moments when To Do lists become encyclopedic in volume.

At the risk of sounding a little overwhelmed (is it possible to be just plain "whelmed?"), I need to step back from some of these spinning plates and see if I can regain better balance.  Unfortunately, the CGM is not playing according to my master plan. 

On Tuesday morning, I put in a new sensor early in the morning, before I had to catch the 6:44 am train to the city.  Since I didn't want to wake Chris up and ask for his groggy assistance, I opted to place the sensor on my left thigh.  Standing in the bathroom, I leaned against the counter and pinged the sensor needle into my leg.  I pulled back the needle and gave the site a little press to secure the sticky tape underneath. Looked up at the counter quickly to gather up the medical waste, then looked at my leg.

Which appeared to have been shot.  With a rifle.  

There was a ton of blood streaming from the site, running down my leg.  I had to grab a quick wad of toilet paper and mop it up.  Knowing the train was coming in twenty minutes and I was still standing in my bathroom, I had to slap on several bandaids, hoping I wouldn't end up with a stain of sensor blood on the leg of my pants.  No time to become upset.  Must work through the frustration.

Bloody CGM sensor.
 

Grabbed my stuff and ran for the door, scurried downstairs and bolted to my car.  I drove to the train station and ditched my car in a no-parking zone, seeing the lights of my train in the distance.  Running like a madwoman, I dashed for the train, the site aching with every sure-footed step.  My tickets were printing as the train was pulling up to the platform and I raced into the nearest compartment. 

After finding my co-workers on the train and connecting the transmitter to my sensor site, I hoped that the day would settle down and I'd enjoy the seminar in NYC in freaking peace.  

No luck.  

The CGM pinged all day long.   "Bad sensor."  "Cal error."  "Enter BG Now."  I calibrated the damn thing four different times, had to restart the sensor once, and even after it settled down and started throwing results, the numbers were in a completely different path than my meter numbers.  Meter said 130 mg/dl, sensor claimed 246 mg/dl, throwing high glucose alarms and generally wagging it's finger at me.

Yes, I was calibrating while my numbers were steady.  I was avoiding eating so that I could hit some semblance of stride and ensure that the sensor was getting solid results.  It just wasn't working fast enough.  I understand that this technology takes time to become acclimated to and that the first day of a sensor is the most trying, but the ache in my thigh, the blood dried on my leg, and the frustration of dealing with a crying sensor instead of focusing on the seminar put me over the damn edge.

I ripped out the sensor on Tuesday night, upset and frustrated, burnt out and discouraged.  I haven't put another one back in yet. 

I pay my diabetes plenty of mind on a daily basis.  I test very, very regularly, I eat well, and I wear an insulin pump in efforts to deliver my insulin doses with precision.   I exercise more than most non-diabetics I know.  I feel like I give this disease - this body, this life - my all. 

I'm not sure I can give it more than I feel it deserves.  I'm struggling with this issue today, unsure of how to proceed.  I know that real-time results can show patterns in management and can also help protect me from the ebb and flow of highs and lows.  But when the numbers aren't correct, the alarms are beeping, and I'm spending more time dancing with a device instead of enjoying the day, I start to question the quality of life associated with some of this technology.  

I know many of you have worn  CGM devices.  How do you feel about them?  From your experience, is there a "best time" to start on one?  (As in:  Am I over-extending myself by trying this during a very stressful and chaotic time in my life?)  For someone who has worn a CGM long-term, how long did it take for the sensor to become part of your routine?  Are the results worth the hassle

I'm at a diabetes crossroad, frustrated and not sure what to do.  Any advice you guys have to offer would be greatly appreciated.

SUM Tags: , , , , ,

January 22, 2008

An Open Letter to The Edges.

Dear Edges,An Open Letter to the Edges.

You've been a part of my life for as long as I can remember.  When I was a baby, I used to lean on you in my crib.  Then there was that day when I was two years old and broke my nose against you on the fireplace.  My mother used to keep my baby bottles on you in the kitchen.

Oh Edges, you've been around forever!  From resting my elbows against you on the table in anatomy class senior year to the you above my bed where I had a library of books, you have always been there.  And we've lived in relative harmony, until the last few years.

Edges, I know you know what I'm talking about.  Listen, I understand that I've added these shifting bits of technology to my body - a pump infusion set on the outside of my thigh or on my abdomen, or the CGM transmitter on the back of my arm or on my hip.  I realize this adds an additional inch, maybe three inches at best, to my overall surface area.  But must you grab at these bits so much?

Was it really necessary for you to snag my pump site over the weekend?  I was undressing for my wedding gown fitting and the edges of my pants caught a small bit on the infusion set.  Granted, I moved slowly enough to thwart a complete site removal, but still. 

And did you really have to reach out for me when I was picking through my jewelry box this morning in search of the stupid matching earring?  I leaned against the edge of my dresser and didn't realize I was pressing up against the infusion set until I stood up straight and felt that ping of pain when the feeling came back to my thigh. 

But the last straw was this afternoon at work.  You know exactly what I mean, when I was talking with H about something and then I turned around quickly.  It was like you came darting out at me, snagging my shoulder on you and pulling the CGM transmitter almost cleanly from my arm, but not cleanly enough that I was sure it came out.  Just enough so that it stung in that oddly warm and slightly painful way, enough to make me wince but not enough to make me grimace.  I had to go into the bathroom at work, push up my sleeve almost to my shoulder, and see the sensor needle dangling from the back of my arm like a tooth that just needed a quick tug to come free.

Edges, I had just put that sensor in this morning and it was calibrated perfectly.  The results were working and I was watching my afternoon trend happily away.  But you had to reach out and say hello, didn't you?  Couldn't just sit back and let me sport this sensor for at least 24 hours before you grabbed it and yanked it out?

I am putting another one in today.  I am going to use my leg, I will tape it down to eliminate any variables, and I expect you to keep your grabby little edgy hands off of it for at least three days.  Three days, damnit. 

If I have to walk around with a giant nail file and round you all out, I will.

Best,

Kerri.

SUM Tags: , , , ,

January 15, 2008

CGM Sensibilities.

An Exercise in Jotted Thoughts, by Kerri Morrone:

Ahem.

I am on day five of the sensor (placed it last Friday into my arm) and it seems that the longer I MiniLink transmitter - photo from Google.wear this, the more accurate the results become.  Last night, I tested with my OneTouch and saw 132 mg/dl.  My CGM said 130 mg/dl.  I'll take that.  I just want accurate results.

The thing is, this sensor stung a bit going in.  The site itself is slightly reddish and a little sore to the touch.  I know I should change the site today, but I'm reluctant to because I don't want to wait the 24 hours for decent results again.  I spoke with another Minimed Rep last night and she told me that the first 24 hours tend to be a little dodgy for everyone.  It's a difficult decision, making the leap from "trialing" to "purchasing."  Every time it buzzes when I'm high or low, it's hard to think about taking it off.  But every time it buzzes because it's bored or lonely (or whatever the hell it's buzzing about), it's hard to think about not feeding it to the cats. 

I'm still on the fence as to its place in my diabetes life.  But for now, I'm trying to learn from this experience.

I was working out last night at the gym and during my run, watched my numbers hold steady for about 15 minutes, then make a sharp turn towards hypoglycemia.  Testing to confirm and then taking a quick swig of juice, I finished my cardio workout at 108 mg/dl.  Watching workout trends helps me better determine when I should hit the ol' juice bottle and when I need to watch out for falling sugars. 

Also during my workout, while wearing a sports bra and a tank top on the treadmill, I noticed a woman staring at the exposed sensor on my arm.  It made me feel self-conscious for a minute, then oddly empowered.  Go ahead and stare, lady.  See if you can find it next week, when I put the transmitter somewhere else. 

One thing I'm definitely picking up on, like I did with the Dexcom, is that my numbers cruise around when I'm not counting carbs with precision.  I know this sounds like diabetic common sense, but when I bit into that sharon fruit this morning, I didn't bolus for the actual carbs, but I dosed instead for the estimated carbohydrate content.  Apparently, this sharon fruit had more than 18g of carbohydrate in it - more like 22g - and my numbers after consuming were in the 190 mg/dl range.  Lather, rinse, repeat.  If I want a tight A1c, I need to buckle down and pay attention to all the details, both delicious and detrimental.

It's been a week of serious diabetes stuff, with tangled emotions and blood sugars alike. 

Good thing I had a little Siah Sausage to wake up to this morning, her small nose pressed against my cheek and her paws on my face, the sound of her purring like a jet engine in my bedroom.  It felt strange to wake up laughing.  Damn cat.

SUM Tags: , , , , , , ,

January 14, 2008

Sleep Deprivation.

When I was in college, I carried a full load of credits every semester and also worked a full-time job as a waitress.  My life was a swirl of 6 am breakfast shifts, afternoon classes, and closing the restaurant at night, not to mention the ridiculous parties we threw on the weekends. 

Needless to say, my hours spent sleeping were limited.  But for some reason, I functioned without too much issue.  (I should also add that during these ridiculously scheduled days, my A1c was dancing around the edges of double digits and my parents were in the middle of a very tumultuous divorce, so my physical and emotional heath were not at their respective bests.)

I'm several years past college at this point, yet still keeping the same kind of schedule.  I'm up early for work, spending nine hours at my job, hitting the gym on weeknights, and staying up late to work/watch movies/hang out with Chris/dine out/whatever.  Most often, my head connects with my pillow past midnight and the alarms start clanging around 7:15 in the morning.  The biggest difference this round is that I'm a. not drinking nearly as much and b. my A1c is tighter.

The sleep debt is starting to affect my credit.  ;)

I've had some trouble sleeping for the past week, thanks to alarming CGMs, pathetically meowing little gray cats, the power of a late night cup of coffee, and the thoughts being tumble-dried in my brain at all times.  Last night, I worked on some freelance projects until almost midnight, then spent three hours dealing with a lingering low blood sugar that refused to budge (and the CGM refused to stop bleating at me).  Was it the intensity of my run yesterday afternoon?  Is it the fact that I was back on the hormones in my birth control pill?  Is the the fact that I have a wedding gown fitting this weekend and can't stop thinking about it?  Was it the project I was immersed in last night, my brain excitedly churning out new ideas? 

Whatever the reason for my insomnia, it's taking a toll on my diabetes.  Even though it seems to be "all the rage" to be a twenty-something who crams everything she can into a 24 hour day, I don't know if this pace is something I can keep up.  Taking a spin through the 24 memory on my MiniLink, I see that I'm normal-to-low all night long, then taking a sharp spin into the oblivion of the 200 mg/dl range around 10 am and hovering there for about two hours.  Hmmmm.  I'm not going to react to this until I see it a few more times, but it's definitely something to keep an eye on. 

Sleepless nights cause distracted days for me.  I'm getting my work done and burning through my to-do list, but I'm not feeling very creative.  I'm also having a harder time reacting to my numbers.  MiniLink beeps that I'm over 160 mg/dl and I clear the alarm but don't check the insulin-on-board and lace in a correction dose, if necessary.  I'm just plodding along, drenched with apathy and craving a nap.  It's like diabetes is just a blip on my sleepy radar. 

Tonight, I will go to bed early, task-list be damned.  And I'll be bright-eyed and inspired for tomorrow, ready to deal with all the curve balls that life, including diabetes, can toss my way. 

Do sleepless nights affect your diabetes care?  How do you deal?

 

SUM Sleepy Sheep.

SUM Tags: , , , ,

January 11, 2008

What's Best.

Last night, Chris and I wrapped up on the couch and watched Signs.  As we watched the movie, I felt Chris absently start rubbing my shoulder.  His hand started at the top of my shoulder and went down towards my elbow.  I felt his fingers skip up against the CGM transmitter.  It made my eyes fill up, and I’m not exactly sure why.

I have been receiving some good data from the MiniLink so far.  It has confirmed that my overnight basals are pretty much spot-on, with a small bit of tweaking to be done for the weekends, when I sleep past 7:15 am.  It has shown me that my run at the gym makes my blood sugar plummet after about 15 minutes.  I like being alerted when my blood sugar is over 180 mg/dl because I want to spend as much time away from that high end as possible.  I feel somehow safer wearing this device; a watchdog while I am otherwise indisposed.

All of this information can help me better manage my diabetes.  Tight control can help me reach my goals of good overall health.  I’m being proactive.  I am testing and bolusing and making use of the latest diabetes technology in efforts to live a long and healthy life

That is what’s best.

It’s just hard to be so focused at all times.  I've been emotional lately.  I lost my edge.

Today, the alarm sounded on the CGM all morning long.  “Bad sensor.”  “Cal error.”  “Bad sensor.”  “BG Now.”  This rotation went on for three hours.  I had resolved to leave the sensor in and go home at lunch to change it out, but after a series of seven errors in a row, I stormed into the bathroom at work and ripped out the sensor early.

I went home at lunch and inserted another sensor into my arm, with Chris’s help.  It was the first sensor we had done on our own, so I had some trouble figuring out how to pull the needle out.  I tried.  Chris tried.  Unfortunately, we were tugging at the wrong angle and my arm became a bit mangled in the process.  The long needle remained stuck in my arm as I tried to wiggle it back, with Chris holding onto the side of the sensors.  Feeling under the weather both physically and emotionally, with the bruise already visible on my arm and a sharp pain edging down towards my elbow, I burst into tears. 

“I can’t get this out.  It hurts a lot right now.”  Tears, without asking my permission, fell into my mouth.  “I can’t do this.”

“We’ll figure this out.  It’s okay.”  Chris grabbed the CGM manual and started flipping through the pages, looking as quickly as he could for the page about removing the needle.  Frustration mounted, along with the soreness from the lodged needle, and I pulled the set from my skin.  Blood poured from the site.  Tears streamed from my eyes.  I felt defeated and frustrated and foolish.

It took several minutes to calm down.  It wasn’t about the sensor mishap.  It wasn’t about the infusion set two nights ago that stung all the way down to my toes.  It wasn’t about the low that had me sweating as I slumbered last week.  It wasn’t about the counted carbohydrates or the glucose tabs in my car or the press releases that I read every day, outlining diabetic complications.  It was simply an overwhelming sense of everything.

What’s best for me?  Is it all this concentration on diabetes?  Is it taking advantage of the technology that this decade, this job, and this blog have given me access to?  My physical health is of the utmost importance, but I value my emotional health just as much - maybe more - than I value my A1c.  Lately, my emotions have been capped up to keep me focused on my numbers.  Today, the bottle uncorked and they flooded me, leaving me bleeding and vulnerable and crying.

I dried my tears.  Chris gave me a hug.  I asked him what I should do.

“Do what you think is best.  I support whatever you decide, baby.”

Sometimes it just takes a good cry and knowing that you’re loved to make it easier to realign your heart and your head with "what’s best."

He helped me insert another sensor into my arm.  We were calm and focused.  It didn’t hurt at all.  It only bled a little, and he grabbed a tissue and blotted the blood with careful hands. 

“See?  Much better that time.”

“I was afraid if I didn’t do it again, right away, I would have given up for a while.”

He nodded.  I rubbed the sensor on my arm, telling myself that it was worth trying, that my moodiness would pass.  The pump was hard to adjust to at first, too.  Everything has an adjustment period, even what’s best.

I opened my mouth to tell him I loved him, but the sounds of the cats fighting over a cardboard box in the living room distracted us both.  Siah was leaping in and out of the box like a little gray gazelle.  It made us laugh.  And the laughter felt right.  I felt lighter.

Siah Sausage looks like she doesn't have a thought in her damn head.

Laughter, for me, is what's best.  It helps make sense of the rest of it.

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January 10, 2008

SUM Questions Answered.

I've received a few questions about the Minimed CGM in the comments and I wanted to address them here, because when I started to answer in the comments section, I was waaaaaaay too wordy.  Here's the MiniLink FAQ, answered with my limited three day knowledge base.

Did your insurance cover your CGM?I love Legend of Zelda.

I had the good luck of finding a Minimed Representative who would let me trial the CGM for a few weeks in order to make a decision about making the MiniLink a permanent part of my diabetes management plan.  So this CGM is cost-free at the moment, or at least until I give it back and buy my own.  ;)

However, I have spoken to my insurance company, my various medical representatives, and other diabetics about getting insurance to cover a CGM.  The feedback varies, but the common theme seemed to be "need-based coverage."  At this point in my life, I have an A1C under 7% (believe me, this was a battle), I have not visited the emergency room as a result of diabetes issues, and I have not called the paramedics due to hypoglycemic unawareness.  From what I'm told, insurance companies look at me and think that I did fine without a CGM before, so there's no need for me to have one now.

Per usual, I don't agree with the sentiments of the insurance companies.  With my wedding in less than 5 months and motherhood on my radar, I want my diabetes to be as tightly controlled as possible.  Wearing a CGM to ward off excessive highs and to protect me from debilitating lows sounds to me like a terrific way to prepare my body for babies.  That's not reason enough to be approved for coverage?  I don't like being told that the only way I'll get a CGM approved is if I'm visting the emergency room.  Shouldn't the point of having access to this technology be aimed at preventing those moments, not reacting to them?

More on insurance coverage in the coming weeks, as I decide what role a CGM will play going forward.  But believe me, I will not go quietly into that insurance mess. 

What I want to know is how you got the sensor in your arm.

Ah, tricky one, this.  Thanks to my friendly neighborhood Minimed rep and my inability to be completely shy, my rep helped me place that sensor on my arm.  Otherwise, I'm not sure how I would have held the sensor in place while withdrawing the needle.  Even now, as I change the bandaids that hold the transmitter in place, I need to enlist Chris's help.  I don't think I could have placed it effectively without help. 

Does it feel weird to have it in your arm, though?

Not really.  Since I don't like employing my abdomen as a holding place for diabetes devices, I was happy to use my arm for this first sensor.  I have to be careful when I take my clothes on and off (like last night, when I almost ripped the transmitter from my arm with my bra strap), but I encountered that with my thigh sites when I first started using those for pump sites.  My brain just needs to adjust.

I did have a little trouble at the gym two nights ago, during my run.  Thanks to the bandaid becoming a bit unsticky and the fact that I was wearing a sleeveless shirt, the transmitter became a little loose and started shaking about.  I had to cut my cardio short to keep the sensor from flying out, but my next plan is to wrap a light ACE bandage around my bicep to hold the MiniLink in place.

I wanted the CGM to be unobtrusive and discreet for this debut.  The arm placement helped me achieve that comfort level.  Now I feel less daunted by the technology and more apt to try different placement sites. 

I'm happy to share my experiences with this device, and to answer questions as honestly as I can.  Thanks for your questions, and let me know if there is anything you're curious about, or what your experiences have been like.  I'm so new to this device that I appreciate all the feedback on it, good or bad, that I can find.

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January 09, 2008

The Best Laid Plans of CGM.

Meep meep, says the Roadrunner Sensor.11:30 pm. 

Meep meep meep.

"What?"  This thing sounds like a little RoadRunner attached to my hip.

More mournful this time.

Meep meep MEEP.

"What is it?"  Exhausted from the night before, nursing the beginning of a nasty head cold, and already tucked into bed, I snake my hand under the covers to retrieve my pump from the waistband of my pajamas.  The screen beams green light my way - "BG HIGH.  Above 180 mg/dl target." 

"Okay, okay."  After clearing the alarm, I grab my meter from the bedside table to confirm this result and, sure enough, I'm 202 mg/dl according to One Touch.

"Here."  I push against the buttons and bolus up a unit, realizing I'm talking to my pump the same way I talk to my cats when they wake me up early in the morning to fill their empty food dishes.

The beeping stops.  I rest my head against the pillow and fall into a deep, blissful sleep, with the pump on my hip, the infusion set on my thigh, the CGM on my arm, a cat at my feet, and my fiance by my side.  Full house.

What happened next is not something I remember clearly, but the memory of my machines filled in the gaps for me.

3:19 am - Pump Alarm.  BEEP.  BEEP.  BEEP.  LOW BLOOD SUGAR.  64 mg/dl  WAKE UP, KERRI.  WAKE UP.

4:08 am- Meter Result.  49 mg/dl.

7:15 am - Morning Carnage.  One empty juice bottle, meter unzipped and used test strips all over the floor, covers tossed off in my low-induced sweat, body freezing due to being exposed and damp all night long.

Oh CGM, you tried to warn me.  I changed my low glucose threshold value to alarm at 65 mg/dl and you did.  You just weren't loud enough.  Or maybe I just turned you off, like I have mistakenly done with the alarm clock on occasion.  Either way, the best laid plans of my CGM were thwarted (or at least muffled). 

Today, my numbers have been all over the place.  I know this because instead of the plateaus of graceful blood sugars, I'm seeing stock market indexes all over the screen of my pump.  Thanks to the sneezing, stuffed up head, and feverish feeling I'm currently enjoying, I at least know why my numbers are erratic.  Even though we've just started our relationship, now CGM and I can enjoy a head cold together and I can see how my numbers dance when I'm feeling ill. 

I have so much I want to write about - the CareLink software that I'm going to try out tonight, my challenges and successes with CGM-ing at the gym last night, and the insurance angle of things, but I'm almost fully immersed in this freaking sneezy cold and can't form another complete tho ...

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MiniLink, Armed.

MiniLink sensor in my arm.My Minimed rep was meeting me at the dLife offices after work to hook me up with the Medtronic Minilink and I joked in an email that he should hoot like an owl upon arriving so that I would know he was there.

Around 6 pm, my cell phone buzzed.  The message left was not someone saying, "Hi, Kerri.  [RepName] from Medtronic calling," but instead, "Whoooooooo!  I'm here."

That's the mark of someone who's on my level, that's for damn sure.

After exchanging grins, we settled ourselves at a table at a local coffee shop and laid out our drug paraphernalia on the table.  The box of CGM sensors, the MiniLink transmitter, the insertion device, and our respective glucose meters (my rep is also type 1) littered the table.  Conversation flowed easily as he set me up with the MiniLink.

"Okay, so now we're ready to place the sensor."  He loaded up the inserter with my first MiniLink sensor.

"Great.  Let's pop that in on my arm."

He paused. 

"Inserting a sensor at a coffee shop is a first, that's for sure.  But in the arm?  This is a series of firsts for me." 

With a little help and almost no pain at all, the sensor was inserted and the transmitter connected.  (I didn't have the opportunity to take pictures of the actual insertion, but I will do a photojournal for the next sensor I use.) 

After the first three hours, the pros and cons were beginning to show themselves. 

PROS:  The sensor is small - about the diameter of a quarter (maybe a small bit bigger) and about three stacked quarters high.  It's on the back of my arm and is pretty low-profile.  It's also water-proof, so no crazy-sticky shower patches that leave red rings on my skin for days.  The MiniLink transmitter, like the Dexcom, takes two hours to fully calibrate when you first put the sensor on.  (This term is called "wetting," which I think is revolting.  My rep and I called it "percolating."  Much less icky.  And hearkens to coffee, which I need desperately.  I'll explain why in the "cons" section.)

This sensor also works in tandem with my Medtronic 522 insulin pump, so I'm toting around one device instead of a receiver and an insulin pump.  It also is able to calibrate using any glucose meter, so I could continue on testing as usual, using my One Touch Ultra2.   One hub device is a huge selling point for me. 

CONS:  The transmitter is floppy and needs to be secured against my skin with a bandaid to keep it from coming loose or dislodging the wire.  This is the biggest con for this transmitter so far.

HOWEVER:  This frigging thing kept me up all night long.  After being instructed that the CGM results are about 15 - 20 minutes behind my actual blood glucose (i.e. the CGM says 100 mg/dl, my sugar is actually 80 mg/dl or thereabouts), I set my low glucose alarm for 80 mg/dl, assuming my number would actually be close to 60 mg/dl once the alarm sounded. 

Thanks to my vigilance with my overnight basals and the fact that they're set with precision, my numbers run close to 90 mg/dl all night long.  Due to this tight control on my overnights, the low glucose alarm went off eight million times last night.  That was issue one.

Issue two involved another alarm - this one reading "Bad Sensor."  Unfortunately, this alarm went off at 2:53 in the morning and I was not going to wake up again just to reinstall a new sensor.  So, against the advisement of my Minimed rep, I manually told the pump that I had installed a new sensor and recalibrated it.  It reset its timer for the two hour calibration, thus waking me up again at almost 5 am. 

Then the low glucose alarm went off again at 6:15, because I was 79 mg/dl.MiniLink - ha ha ha ha ha!

(Note to self:  Kerri, set the low glucose threshold at 65 mg/dl, for crying out loud.  Or you may never sleep again.  Seriously.  Every time the thing went off, you groaned, the cats howled, and Shoes most likely plotted revenge.  Raise the threshold.  Do it now, you silly girl.)

I have not slept well, but it's obvious that my numbers hold tight and steady throughout the night.  I'm hoping last night's escapades were a fluke thing and that a little tweaking will have me living in relative harmony.  

I'll have more on the technical aspects of this device throughout the week, but for now I'm going to check my number - ah, 113 mg/dl on the Link, 99 mg/dl on my OneTouch - and get another cup of coffee.

I am MiniLink.  :)

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August 10, 2007

Another Round as the Dexcom Warrior.

After a whirlwind week of travel, eating sloppily, and missing a few crucial workouts, my blood sugars were in a tailspin of chaos and I needed to reign things in.

I grabbed my flashlight and sent out the Dexcom Signal. 

Sending out the Dexcom signal.

Help me, Dexcom!

Dexcom responded with a shrill cry and leapt from the box.  Within a few minutes, the sensor was making its first appearance on my outer thigh and I started the two hour calibration waiting game.  (And why do I always start this thing at ten o'clock at night, forcing me to be fussing around with diabetes toys at the stroke of midnight?)

As I prepared for Round Two as the Dexcom Warrior, I noticed that I was very particular about where I chose to pop in the sensor.  Last time, I wore the site on my abdomen and while it was accessible and easy to put in, it bumped up against every piece of clothing I wore and was visible underneath both my gym clothes and my work attire.  As someone who prefers to keep all diabetes hardware relatively quiet, I opted for a thigh site this time.

I inserted the sensor, which pinched a bit but not to the point where I clenched my teeth, and pulled out the needle, leaving the hub attached and the wire inserted.  (Yes, this sucker has a wire in there instead of a plastic cannula.  If I think about it too much, it makes my stomach feel a bit queasy, but I couldn't feel it at all when it was in there.)

With my pump infusion set on my right thigh and my Dexcom sensor on my left, I felt like some kind of diabetic pack mule.  My hips felt vulnerable, as though banging into any door jamb would send me into a robotic meltdown. 

My euphoria wasn't as intense for this second round of testing.  No Techno-Joy.  (Cannot access printer?  But it's here.) I wasn't obsessed with the new gadget, but instead treated it like it was "just another meter."  I traveled with the receiver in my purse and kept it on my desk while I worked, instead of forcing myself to keep it clipped to my clothes.  Not wearing the receiver felt liberating. 

I noticed it physically, though, while I was at the gym.  Lying on my side for an ab exercise, I felt my pump infusion set mashing against the floor.  When I flipped to work out the other side, the Dexcom sensor was pressed hard on the floor.  I remember back to when I had the sensor on my abdomen and I felt it pressing then for sit-ups.  While I appreciate the technology of this device, I would appreciate it even more if it were smaller and less intrusive.

For anyone who thinks the Dexcom results are supposed to perfectly match the glucose meter results, that's not going to happen.  While I had some very closely matching results, the Dexcom remained a bit higher, on the whole.  Like here:

Overnight readings

This reading of 146 mg/dl was countered by my meter as 101 mg/dl.  Bit of a difference there.  But the trending I saw was spot on.  That 101 mg/dl (or 146 mg/dl according to Dexcom) was the upswing of a 72 mg/dl I had earlier in the morning. 

More Dexcom readings.

And then I watched as the correction for the 146 mg/dl brought me back town towards 120 mg/dl.  I like that positive reinforcement that my insulin is working and that my body is able to hold steady for a spell, despite the fact that I'm trying to compensate for a busted pancreas.

I gained a good feel for what times of the day I needed to pay more attention.  (Can anyone say "late afternoon snacking tendency"?)  I also noticed that wearing the site on my thigh instead of my abdomen made me less aware that I was sporting the site in the first place. 

Dexcom and I have parted ways once again, as I need to order more sensors.  Onward towards the weekend, where the Rhode Island Film Festival and a concert in Boston await!  See you Monday!

July 02, 2007

All or Nothing (once more).

Saturday afternoon, I removed the Dexcom sensor. 

For the record, that Dexcom is worth the design flaws and I was very impressed with the results.  (More on that later.)  But also for the record, pulling out the sensor was extremely painful - that adhesive is intense!  I had to use a damp cloth around the sticky gauzey bits to help alleviate that "peeling my skin from my body" feeling.   Why didn't I apply a new sensor?  Due to the upcoming July 4th holiday and the white-water rafting trip this weekend, I didn't feel comfortable toting around an additional gizmo that couldn't get wet.  So off it came, to be reintegrated next week.

Saturday night, I removed my insulin pump.

I decided to take a "pump vacation" for the rafting trip, based on my insecurity about being able toLantus in lieu of my pump. properly protect it and my fear of it being busted on the excursion.  (I thought a lot about the advice to order a back-up pump, use the AquaPack, etc. but I had to go with my gut on this one.)   So late Saturday night, I disconnected my pump and took my first shot of Lantus in almost four years.

I was at Batman's house, spending the night before I headed up to Boston to retrieve Chris (yay!) from the airport.  

"Ah, the red ladybug bag!"  Batman exclaimed.  (It was a Clinique "free gift" from several years ago - a red circular zippered case that was plastic and held my insulin bottles when I was on injections.)  "I remember that thing!  I also remember when you went on the pump in the first place.  Is this weird?"

"Definitely."  I uncapped the syringe with my teeth and put the needle tip into the new bottle of Lantus, drawing back 16 units.  "This is completely bizarre.  But it's only for a week.  Just until Sunday night."

It's been two days without it and I'm feeling pretty good.  I am back on my old dose of Lantus (15 1/2 units at 10 o'clock at night) and I'm bolusing with an insulin pen.  Between you and I (and the entire internet), I miss my pump and I feel like I'm walking around naked, but this brief vacation is just that:  brief.  Blood sugars have been closely monitored and in a holding pattern of about 150 mg/dl, which is higher than I shoot for but I'm happy to have them steady instead of bouncing.

This is weird, though, going from two savvy devices to nothing more than an insulin pen in my purse.  Weirder still (yet comforting) is the fact that Chris has never known me without my pump.  It's always been a part of our life together.

After rescuing my fiance from the airport (at 7 am in Boston - damn that's early), I gave him a huge hug and then shared my secret with him.  "I'm not wearing a pump today."

His arms circled my waist and he gave me a kiss on the head.

"I never notice even when you do." 

Welcome home, Chris.  I'm so happy you're home!

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