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April 03, 2013

Pump Peelz.

Diabetes devices are boring, but I'd rather they be boring and useful (read: accurate, precise) than to have spangly, sparkly bits and a dozen different color options.  I don't want glitter being what holds up an FDA approval.

But having a way to dress up your diabetes devices, even just a wee bit, can go a really long way in psychosocial satisfaction.  Which is why I think the Pump Peelz stickers are clever, cute, and customizable.  The genius is in the simplicity of the idea:  a sticker on the exterior of your device to give it some personality.

Behold!  A Dexcom G4 receiver, ready for its close-up:

Dressy!
My receiver is wearing the Little Polka dots, and yes, I already treated the low.

Founded by high school sweethearts (awwww!) Emily Hixon (diagnosed with T1D a few years ago and currently a Pump Peelz exec and photographer) and Scott Imblum, Pump Peelz are stickers specially created for Dexcom G4 receivers, Omnipods (Gen 1 & 2), and VerioIQ meters to give a little boost to these often unfriendly-looking devices.  

As someone who is fine with a plain insulin pump and a plain meter and doesn't make a habit of fashionably fiddling with my devices, I was surprised at how much I liked the new look of my Dexcom receiver.  Maybe a little bling is good for my insulin-deprived soul.  Or maybe the toddler in my house has convinced me that stickers are awesome.  Either way.

You can check Pump Peelz by visiting their website, and you can stick them to your devices through the magic of those sticky stickers.  Go, science!

Disclosure:  The Pump Peelz team sent me items to review at no cost to me. 

February 27, 2013

Humalog vs. Novolog.

It wasn't until recently that I started thinking about building up a tolerance to insulin.  Do you build up a chemical familiarity, a resistance of sorts, to a drug after taking it for ... oh, say a few decades? Do PWD eventually become the Dread Pirate Roberts, building up a tolerance to iocane powder

"I realize this is probably ridiculous, and I'm sure there aren't any studies on this," I said to my doctor the other week.  "But it has prompted me to want to try a different kind of fast acting insulin, to see if I have better results.  Is that something I'm able to do, to have a script written for a one-off in order to assess how the insulin might work for me?"

"We can do that."

And I left the appointment, expecting my pharmacy to auto-dial me when my order was complete.

Instead, a three-month supply of Novolog ended up on my doorstep, having been accidentally shuttled through my mail order pharmacy and eating up my insurance order that was intended for my normal course of Humalog. Which is why I'm experimenting with Novolog for the next few months, as a result of a shipping error. 

Does it even matter?  Jury is still out for me.  Also, the smell of the maple candle my mom bought us is making my head hurt.  I'm throwing it out today.  So ends this aside.

I've been taking Humalog for over ten years, after switching from Regular insulin before starting on my insulin pump, so I feel like I'm familiar with how Humalog acts in my pump and on my blood sugars.  Switching to a different, but similar, rapid-acting analog should hopefully be a seamless transition.  Last night was my first pump-load of Novolog, despite the last unopened bottle of Humalog in my stash.  (I didn't want to use up the Humalog entirely, then switch to Novolog, because if I absolutely hated the new insulin, I'd be stuck with it.) 

So far, last night was entirely uneventful, and the biggest change I've noticed (in less than 24 hours of use) is that the bottle of Novolog plays host to way more bubbles, which I hope doesn't translate to a bubblier reservoir.  I'll have a better sense of how this insulin plays once I dial in a few meal boluses and then watch the Dexcom graph play out.

Has anyone switched from Humalog to Novolog?  Or Novolog to Humalog?  The responses to this question, when I posted it on Facebook, varied quite a bit.  Did you notice any changes?  Does it all come out in the wash?  (And if that's the case, why were you washing it?)  Or is it like the Pepsi Challenge, where some people just can't tell the difference and others are left with a bad taste in their mouths?  

February 12, 2013

A Book You Should Read: Islands and Insulin.

Islands and Insulin.  This is the first book I've read, in full, in a long time. I need to read more. The day before I headed out on flight to Nashville, TN, I received a package in the mail.

"Mommy, that has sunshine all OVER it," my daughter exclaimed happily, running her hands over the bright yellow paper that covered the package.

"I know, right?  Let's see what's inside," and we tore open the box to find, among other beach-esque trinkets, a book written by Erin Spineto, titled Islands and Insulin: A Diabetic Sailor's Memoir.  A note from Erin, author and fellow PWD, encouraged me to take some time away from my schedule.  Part of her note read: "You deserve a break. So sit back, feel the sand beneath your feet and listen to the ocean for a moment.  Grab a cool drink and enjoy a good beach read while you bask in the sun.  Islands and Insulin is the story of a girl given a boat, one hundred miles of ocean, and way too much caffeine to reflect on how an incorrigible disease has altered her voyage into adulthood ... all wrapped up inside a diabetes survival manual."

You know what?  Yeah.  I want to sit back, relax, and do something on this flight other than slog through emails.  So I tossed her book into my bag with intention of spinning through it while I traveled. 

What I didn't expect to do what read the entire thing.

Erin's book is about her diabetes experience - her diagnosis, her disclosures, her journey as an athlete and adventurer - but it speaks to the collective experiences we all share.  How diabetes challenges us, but can also serve as a catalyst to inspire us.  When I read about Erin grappling with motherhood and its influence on her diabetes control, I almost cried with relief that someone else has been there, too, and climbed out just fine. Her experiences as a sailor managing diabetes, alone on the ocean, inspired me. I've wondered how to make this monster bend to me, instead of the other way around, and I love reading about people who understand that completely.

I asked Erin why she thought it was important for people with diabetes to share their experiences, and why she wanted to share hers.  She told me, "I was at an Insulindependence party and a guy I just met shared with me [the story of] the time he had a seizure from a low. He had never told anyone before. Not even his girlfriend. And this sense of relief spread across his face. I realized then that sharing our stories helps heal us ... and also that not everyone has Insulindependence parties. A book could reach those who don't have that interaction."

I read this entire book in one sitting, laughing at some parts, nodding my head in recognition at others, and just marveling at how much of the diabetes experience was captured in 263 pages. Erin Spineto should be proud as hell for being it, living it, and writing it.

You can order your copy of Islands and Insulin on Amazon, and you can follow Erin's adventures on Twitter at @erinspineto.

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.]

October 18, 2012

Timesulin: Informed MDI'ing.

During my short experience back on multiple daily injections (MDI), aka "pump vacation," I made frequent use of the Timesulin pen cap.  This sample was sent to me by John Sjölund, CEO and co-founder of Timesulin, and since I received a few samples, I passed one along to Christopher Angell, in hopes of sharing perspectives from someone who was moonlighting as an MDI'er (me) and someone who is a full-time MDI'er (Christopher). 

For me, the Timesulin pen cap was a fantastic transition tool for me because it helped bridge the information gap.  When I'm using my pump, I have access to information like the amount of insulin on board, the bolus calculator, the ability to micro-dose, etc.  Going from pumping to pens is a tricky transition, because injections don't allow me the ability to fine-tune the way I'm used to.  But this Timesulin pen cap thing helps my brain out, because it provides the basic information of "when did I last bolus?"

That, for a scatterbrained mess like me, is crucial.  I have a tendency to rage bolus when I'm high, and this pen helped me avoid stacking boluses.  I also have a tendency to forget when I last bolused (see aforementioned scatterbrainedness), so the history screen/status screen on my Animas Ping is essential to sanity.  This is where the pen cap comes in, because after being uncapped for 8 seconds (which, according to their research, was the average of how long it took to take a pen injection - we are a fast crew, it seems!), the timer resets, letting you know when you last used the pen.

In my world, the size of the pen/cap didn't register much for me, because it lives in my meter case (a small, but long, makeup bag I bought at Target last year), so it fit fine in there with all of my other supplies (meter, lancets, pump battery, a quarter to change the battery, and spare pen needle tips). 

Christopher also took this pen cap for a test drive, and he was struck initially by the size of the thing (and we'll put his comments in italics, so I don't get tangled):  At first glance, I thought the cap looked comically oversized, as though someone had hit my original cap with a hammer and it had swollen to twice its normal size, or the insulin cap equivalent of the foam novelty hand often seen in football stadiums.  Timesulin (my initial reaction notwithstanding) did a very good job of matching their cap to my Humalog Kwikpen™.  If anything, I would say they did too good a job.  The longer I used it, the more likely I was to simply grab the pen and uncap it, without looking at the timer screen, before remembering that was, in fact, an option.  While I understand the impulse to try to blend it in with existing equipment, a more contrasting/eye-catching design would have kept me more aware of its presence/function, and allowed me to take greater advantage of it.

The timer impacted him, as well, but in a slightly different way: If anything, I would say that Timesulin made me aware of how often I truly forget whether or not I have given an injection.  Not once in the 2+ weeks that I have used it have I used it for that purpose.  That said, it's an important enough piece of information that even needing it and getting it once or twice a year is more than enough to justify the unobtrusive accessory.

What I found myself using it for more than anything (outside of general curiosity about how long I might have gone between injections) was as a timer for showing me how long it had been between bolus and meal.  It was a very helpful reminder to try to pre-bolus for meals I knew were likely to spike me, such as chinese food, as well as a convenient way of tracking when that pre-bolus may have been too "pre" and I ought to consider finding something to pre-empt a pre-meal hypo.  I would leave the pen on the table until my food arrived, so I could keep tabs on the life of my freshly introduced insulin.

Overall, I think this concept is brilliant, in both its simplicity and execution.  Even though I'm back on the pump and have retired my bottle of Levemir back to the fridge until my next MDI dabbling, I still keep the pen cap on my backup pen.  This tool is a powerful, yet straightforward, weapon in my diabetes arsenal. I really liked, and like, having it on hand.



And, for the record, it tracks up to 99 hours and 59 minutes, at which time it sits quietly.  Which makes me uncap it and restart the timer, because I can't help myself.  If you want to check this out for yourself, you can buy one through the Timesulin web store.

October 20, 2011

Opsite Flexifix: You Can Stick Around.

A few days before I headed to San Diego, I slapped on a new Dexcom sensor.  And when I was ready to fly out on Sunday morning, I noticed that the edges of the sensor adhesive were peeling back.  I casually mentioned this to a new acquaintance of mine, and she immediately started talking about "optiflex something tape?" and suddenly, a patch of it appeared from the depths of her purse. 

Which is how I ended up at a conference with my pant leg hitched up to my hip, asking an almost-stranger to tape down the edges of my medical device. 

But this stuff?  Works.  Like proverbial gangbusters.  That Dexcom sensor was on its second-to-last day, and it made it another nine days before the results started to wonk out on me.  (NO I am not advocating that you restart your sensors and try to get more life out of them.  I'm simply saying that the tape helps keep your sensor stuck firmly for seven days.  I just happened to get mad lazy with this one and left it on longer than recommended.  YDMV.)

I mentioned this stuff on Twitter the day after I returned home, but I keep getting the name wrong.  "Optiflex?  Opflex?  Optimus Prime Flex?"  For the record, it's Opsite Flexifix tape:

Behold!  The magical tape!

I ordered mine from Amazon, and when it arrived, it was in a nice, little tight roll (not this kind of tight roll) with a light green grid on the outside of the tape.  My current Dexcom sensor is on its third day, so I thought I'd slap a little tape on it.  I rolled out a short length (enough to cover the sensor edges fully) and cut out a center square (Jim! J! Bullock!) to accommodate the transmitter:

Cutting out that center bit is a little complicated, but small scissors do help.

On one side of the tape, it says "REMOVE FIRST."  I can take a hint; so I pulled that side of the tape off first and stuck it to my thigh (around the sensor). 

Sensor with the Optimus Prime tape around it.

Then I pulled the grid layer off, which left a flexible, bandaid-esque cover (cover band?) over my entire sensor.  It was a little clumsy for me to put on, because the tape is super-sticky and trying to settle it down is like keeping a length of saran wrap from getting all lumpy.  But now it's on, and I don't feel it or notice it, and hopefully it will keep the sensor stuck fully and happily.

Opsite Flexifix didn't ask me to write about this.  They didn't send me free stuff (but if they'd like to credit my Amazon account so I can buy more ribbons for the baby's hair, that would be badass), and they have no idea I've mentioned their product on my site.  But I had to:  that one good turn in San Diego deserved another.  And this Optimus Prime tape stuff rules.

[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?

December 07, 2010

Guest Post: Facebook Isn't Just About Tending Your Crops.

Manny Hernandez isn't just a "friend" on Facebook; he's my friend in "real life," too.  I've always admired his dedication to improving the lives of people with diabetes, and how he uses social media to bridge the gaps between diabetic communities.  Which is why I'm very happy to have him guest posting here today about his Facebook diabetes management game, HealthSeeker.

*   *   *
 
Manny Hernandez and his hatOn Facebook, You Can Also Play to Manage Your Diabetes!
Let’s face it: Facebook is a giant. More than 550 million people in the world use it for keeping up with friends and family, to stay informed, and to be entertained.

At the end of 2009, seeing this trend and realizing how many people on Facebook were playing so-called social games (FarmVille is just one example of these), at the Diabetes Hands Foundation (DHF) we thought we should develop a game on Facebook to help with diabetes management.

With the sponsorship of Boehringer Ingelheim Pharmaceuticals and in collaboration with Boston-based Joslin Diabetes Center, we began to shape  a new game called HealthSeeker. The game saw the light of day in June 2010, when it was launched in English at www.healthSeekerGame.org. The game was launched in Spanish during the month of November (si quieres jugar HealthSeeker en Español visita www.ExplorandoTuSalud.org).

HealthSeeker offers players suggestions to help them improve their lifestyle and nutrition, to better manage diabetes. As a player, you can invite your Facebook friends (actually, it is more fun to play alongside them): they can become sources of inspiration and motivation as you move through levels.

The game tackles two of the risk factors associated with the incidence of type 2 diabetes (though people with type 1 diabetes and all people who simply want to live a healthier life can benefit from it too): the lack of physical activity and the not-so-healthy eating habits we sometimes exhibit.

How does HealthSeeker work?
The game motivates players to take on simple daily challenges, such as switching from wheat to white bread or walking around the block after lunch, in order to help them reach their lifestyle goals.

The lifestyle goals include healthier eating, reaching an optimal weight, improve your diabetes management and reducing the risks of heart problems. HealthSeeker, the diabetes management Facebook game!

The game contains missions and actions that the participants choose. These need to be completed in order to progress. The vast majority of the actions are completed in real life, not in front of the computer. This makes sense considering that we don’t really burn too many calories when we’re not moving anything but our fingers on the keyboard. :)

As players complete actions and return to the game to inform about their progress, they receive awards and points for their achievements and their Facebook friends can give them kudos. Players can also share their accomplishments on their Facebook wall, through Twitter or challenge their friends complete the same missions and actions. This is part of the viral character of the game and is what makes it that much more fun to play alongside your Facebook friends.

As of today, more than 5,000 people are playing HealthSeeker and we look forward to receiving more players. The game is available free of charge, in English at www.HealthSeekerGame.org (en español a través de www.ExplorandoTuSalud.org)

I look forward to seeing you and your Facbeook friends playing soon to take simple steps to get healthier together!

*   *   *

Manny Hernandez (@askmanny) is a nonprofit executive, social media author, and consultant and a diabetes advocate. He is the President of the Diabetes Hands Foundation (DHF) and the founder of www.TuDiabetes.org (in English) and www.EsTuDiabetes.org (in Spanish).


August 18, 2010

Debating Symlin.

I've been reading a lot about people's experiences with Symlin.  I know Super G and Kelly have given it a ago, along with a lot of other fellow d-bloggers.  I gave some thought to trying it a while back, but Chris and I were, at that time, close to trying for a baby, and then I was pregnant, and now I'm breastfeeding - activities that are all a big "NO!" to the question "Can I use Symlin?"

But the kidlet is four months old, and I've begun the weaning process from breast to bottle.  I'm still feeding her in the morning and once or twice throughout the day, but my days of full-time breastfeeding are in the past.  Within the next two or three months or so, she'll be fully weaned and my body will be mine to mess around with again.  (Thinking about adding an extra set of hands - would be useful additions when it comes to changing a diaper while shooing the cat away.)

More realistically, I'm thinking about Symlin.  Once BSparl isn't directly receiving the drugs I am taking, there will be some medical changes to my regimen.  My endocrinologist has already told me that once the baby is weaned, I'll be moving from my blood pressure medication Labetalol to the previous drug I was taking - Altace 2.5 mg.  And I'm already wondering what tools might be at my disposal for blood sugar management, other than insulin.  Like maybe that Symlin character.

IWould you do it? have mixed feelings on the whole "additional drug" thing.  Over the last year or so, I've become sort of hyper-aware of what's safe for a pregnant woman, from deli meat to drugs.   "If it's bad for a growing baby, how can it be good for me?" is the question rolling around in my head almost at all times.  I understand that sometimes it's a risk/benefit situation, like with deli meats (the nitrates aren't great for me, but they could be really crummy for a budding fetus).  Or the Labetalol, which isn't a drug you want to be on during pregnancy, but if I had ditched blood pressure meds entirely, my experience with pre-eclampsia could have started in the second trimester, instead of the third.  Symlin is something that can help tremendously with post-prandial spiking (and additionally, with weight management), according to the claims on their website.  And I like the idea of that extra assistance all the way around.

But I'm a little sketchy on the idea of taking a drug that has some known nausea side-effects.  (I HATE puking.  Hate.)  And then there's the "Hey, you're on an insulin pump so you don't have to worry about injections ... oh wait, here's another injection."  I feel all uppity and self-righteous about adding in another drug, because in my opinion, less is truly more.  One thing about Symlin, though, is that the decision to try it doesn't mean I have to stay on it.  I could opt in for a few weeks and then return to life without it.

So much to think about in anticipation of my November visit to Joslin.  Has anyone used Symlin and survived the icky first few adjustment weeks?  Could Symlin, in addition to exercise, help me toss the last ten pounds of baby weight?  Is this drug worth shooting up?

Inquiring minds:  I haz one.

June 22, 2010

Pregnant With Pre-Existing Diabetes?

For anyone who has been reading my blog since my engagement three years ago, you know that motherhood has been on my radar for a long time.  Longer than marriage.  That quest for a decent A1C, that desire for a "normal" pregnancy, and that hope for a happy and healthy baby.

Buy this book!Part of the reason I wanted to write about my pregnancy here on SUM is because there wasn't a lot of information out there about pre-existing diabetes and pregnancy.  There was a LOT of information on gestational diabetes (obviously), and type 2 diabetes got some good press, but type 1 was sort of swept under the rug.  Thankfully, there were a few diabetes bloggers who had chronicled their journeys, and I wanted to add my voice to that hopeful chorus.   

But also thankfully, Cheryl Alkon had taken the topic to her publisher, and she penned the first book on managing pre-existing diabetes and pregnancy.  And I'm very honored to have been both featured in her book (as a women preparing for pregnancy) and to have her contributing here on SUM:

Doom and gloom. That was the message I got several years ago when I first thought about trying to have a baby while also dealing with my type 1 diabetes. Whether at the doctor's office, going online, or reading the very few books about the subject, trying to get and be pregnant while managing blood sugars, taking insulin, closely counting carbs (and avoiding a lot of low-carb proteins that were good for blood sugars, but bad for babies-to-be) all sounded like a nearly impossible task. One fraught with higher risks of birth defects, overweight babies, worsened diabetes complications, and more.

But I also saw type 1 friends who had healthy babies and sensed what could be possible. This spurred me to research, craft a book proposal, and eventually devote myself to publishing an insider's guide to pregnancy with type 1 or type 2 diabetes. I'm thrilled to say that, five years later, "Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby" was published by Demos Health this spring, and has been enthusiastically welcomed by others who, like me, craved the inside story about how to have a healthy pregnancy and baby while managing diabetes.

I had the pleasure of receiving an advance copy of Cheryl's book just before my baby was born, and even though I was in my third trimester and just weeks away from delivering my daughter, it was so reassuring to read about all the things that could go right.  A diabetic pregnancy is a high-risk one, and the challenges can lead to some tough emotional roller coasters and some scary medical experiences (see also:  stuck in the hospital for a month) - but these pregnancies can also lead to a healthy, happy baby.  (See also:  BSparl)  Touching on everything from pre-conception to managing the months of the pregnancy to post-delivery recovery and how to wrangle in diabetes control once again, this book was exactly what I needed to read while pregnant with my daughter.  I only wish it had gone to press before I had conceived!

If you are a woman with diabetes and you're thinking about becoming pregnant, this book is a good resource for you.  If you are the partner of a WWD (woman with diabetes) and you want the full story on how pregnancy and diabetes can mix, this book is a good resource for you, too.  And if you are the parent of a woman with diabetes and you want to know that your child can have the same chances of a healthy pregnancy as any other woman, this book is a good resource for you as well.  

Cheryl will actually be speaking in Boston in the coming weeks (the first event being THIS WEDNESDAY - sign up!), so if you'd like to hear more from Cheryl in person (and meet my endocrinologist, who consulted on the book with Cheryl), you can attend a discussion this Wednesday.  For more details on upcoming events, check out Cheryl's post on her blog.

Thank you, Cheryl, for giving new moms and moms-to-be with diabetes a sense of peace.  And congratulations on your BIG ANNOUNCEMENT on your blog today!

March 12, 2010

Myabetic: Personalizing Diabetes Management.

I was diagnosed with type 1 diabetes just before I started second grade, back in 1986.  I played with Barbie dolls, colored countless coloring books with my box of Crayola 96 (sharpener in the back), and sported a messy ponytail as often as my mom would allow.  

But my life also included dozens of plastic bags filled with orange-capped syringes.  And black meter cases that zipped up the side and held my glucose meter.  And small vials of bandaid-scented insulin.  My childhood was colorful and fun and just like every other kids', but there were some dreary bits of diabetes management as a running thread.

I wish there had been things like this to hold my meter in when I was growing up with type 1 - because these meter cases are awesome:

I love this case.

This meter case was created by Kyrra Richards, who was diagnosed with type 1 diabetes in 2007.  I think it is GORGEOUS.  After her diagnosis, Kyrra created Myabetic - a specialty store stocked with playful and cool glucose meter cases.  She sent me a few of her meter cases to review here on SUM, and she also offered to share a little bit of her story.  

*   *   *

Kerri:  Hey Kyrra!  What’s your diabetes story?

Kyrra from Myabetic:  I grew up as a dancer and was diagnosed with type 1 diabetes after returning home from a dance tour in Afghanistan.  I had been performing for the troops at military bases and realized that I was out-eating soldiers in the dining facilities.  After guzzling down 24 water bottles in a day and a half, I finally went to the doctor and received my diagnosis just before my 25th birthday.  I began the endless cycle of doctor appointments, lab tests, educator meetings, and waiting rooms.  The physical changes were frustrating, but the emotional obstacles proved to be even more challenging.  I created Myabetic as a way to cope constructively with my diabetes.

Kerri:  How do you think that Myabetic can help make a difference for people with diabetes?  What gap are you guys filling?

Kyrra from Myabetic:  Myabetic was founded because I felt a need to personalize health management.  Although diabetes is a constant struggle, we have the opportunity to take control of our treatment.  Upon my diagnosis, I lacked the motivation and self-worth to properly care for my condition.  Using the standard-issue nylon case only made me feel more ‘sick.’  I personalize so much of my life – my cell phone, computer, license plate – why not do it with healthcare?  We are all strong, unique individuals, and I wanted our daily testing accessories to reflect our personalities.

Kerri:  What made you want to become more involved in the diabetes community?

Kyrra from Myabetic:  The most rewarding aspect of Myabetic has been the opporKyrra Richards, Founder of Myabetictunity to contribute to our supportive, accepting community.  People with diabetes are passionate and strong!  It’s time that our accessories and equipment make us feel the same way.  I love carrying around our cases and am excited to share our products with everyone.  I know they can make a difference and bring smiles to healthy faces.  (Especially since I jumped for joy when my diabetes educator gave me a bunch of purple lancets – it’s the little things…)

Kerri:  If people want to find out more about your products, or want to order a meter case for themselves, how can they get in touch with you?

Kyrra from Myabetic:  We currently have cases for men, women, and children available on our website, Myabetic.  We would love to have everyone become a fan of Myabetic on Facebook and/or follow us on Twitter.  Check out the Community section of our website to find the links.  Also, if anyone would like to contact me directly, my email address is krichards (at) myabetic.com.

*   *   *

Thank you so much for sharing your talents with us, Kyrra!  And in the interests of full disclosure (also known as TMI), I'm sending the free samples I've received from Kyrra onward to some very kind readers who have reached out over the years.  One good turn, right?

(I'm off to Joslin for the day - have a great weekend!!)

February 15, 2010

Disclosure: I've Got One.

Disclosure is the responsibility of the blogger, and we’re under more scrutiny these days than ever before.   But I’ve never had an issue with transparency here – actually, I think I tell you guys way more than you probably want to know.  You knew when I started and stopped working for dLife, you know what publications I’m contributing to regularly, and you know about my relationship with Dexcom.  This blog is about my life with diabetes, and even though I know this is my life that I’ve decided to share, it’s important to me that people know my professional relationships with diabetes companies.  I’d want to know that information if I were reading this blog, too.

So (long winded intro to this post, eh?), I wanted to continue to keep you guys in the loop.  I’ve decided to sign a sponsorship agreement with the Animas Corporation. This whole thing started a few months ago, when I was exploring the idea of a new insulin pump and was excited about the Animas/Dexcom integration (no, I don’t have a CLUE when that’s happening, but I’m mighty hopeful it does go through in 2010).  But I’m still under my current pump warranty, so my hands were tied.  Reps from Animas reached out, one thing lead to another, and now I’m working with Animas, not as an employee, but as part of their outreach program that includes country singer George Canyon, LPGA Golfers Kelli Kuehne and Michelle McGann, and former Miss America Nicole Johnson (to name a few).  The program tries to spread the Animas name by working with people who have diabetes who are doing cool things (pregnancy is cool, right?), can inspire others to consider pump therapy, and want to talk honestly about how diabetes impacts their lives.  Bless their hearts for daring to partner with a – gasp! - blogger.  As part of this program, I’ve switched insulin pumps from my Minimed 722 to an Animas OneTouch Ping and am receiving my pump and pump supplies from the company gratis.  (Don’t worry, my doctor is in the loop and my supplies and pump are still a prescribed item.  This agreement doesn’t replace my medical team – just my method of insulin delivery.)

My new insuiln pump.  With my new, mega-basal rates.  Holy pregnancy!
My new insulin pump, showcasing my new mega-basal rates.  :)

This agreement is similar to the Dexcom one from last year (which is still in effect), in that I’m still going to be business as usual here on SUM.  Like with Dexcom, during the course of drafting this agreement, I spoke at length with many of the folks at Animas and they're well aware that everything I write about won't always be favorable (nothing is perfect, and we’re still talking about needles and diseases here), but what I say about their product will always be honest.  That means that when the pump is behaving itself and working smoothly, I'll say that.  And when I’m frustrated by pump fashion challenges and tangled infusion sets, I’ll say that, too.  This agreement isn’t a filter, but I think it’s important that you, as readers who trust me to be straightforward and honest at all times, know what kind of lens my perspective is seen through.  Just like with anything else.  Like when I tell you that Buried is the greatest film EVER.  (It is.)  Or that my baby is the cutest fetus EVER.  (She does make me smile.)  Or that my cats are the most annoying animals ever.  (I can't stand that gray one.) 

Every blogger is biased, but not every blogger discloses their biases.  I’m trying to do right by you guys, as best I can.

So that’s the latest.  As always, if you have concerns about this, please let me know.  I’m happy to answer any questions (but, just like before, my answer might be “Honestly, I have no idea.”).  And, just like before, if Nikon calls, I’m answering without hesitation. 

January 25, 2010

What's Sexier Than Compression Stockings?

Thanks to the happy combination of Factor V Leiden and being pregnant, I'm rocking a higher chance than average for a blood clot while traveling.  Back in October, when I was just a few months along, a lot of my travel was on the Acela, cruising back and forth between Boston and Philly, in addition to some flights.  So I needed to take these clotting risks into account.

"You're telling me I should pick up some compression stockings, then?"  I asked my obstetrician, after we had discussed my upcoming travel plans.

Compression stockings are cool ... right?  :p

"Yes ma'am.  And wear them.  Not just for traveling, but as often as you can."

"Will do.  So I'll be potbellied and wearing compression stockings.  Hot!"

My feeble attempts at joking aside, these stockings are important.  Even though I'm working hard to get to the gym several times a week, I'm more definitively working hard on making money, so there's a bit too much time spent at the computer these days.  Heeding the advice of my doctors, I'm careful to keep my legs elevated as much as possible, and I'm sure to pop up and walk around every hour or so, in addition to staying hydrated.  (Note:  Staying hydrated makes getting up every hour easier, especially when BSparl is gnawing on my bladder.)  

And I'm also sporting these socks, purchased for $4.99 at my local CVS.  (Another note:  CVS takes too much of my money on a regular basis, from their clever selection of lip glosses - love me some Bonnie Bell - to their strategic arrangement of Hallmark greeting cards to their convenient pharmacy that's open 24 hours.  I have an intense love/hate relationship with CVS, as evidenced by their constant contact with my debit card.)  The socks aren't uncomfortable, they appear to be working well (no varicose veins yet), and they are black, so thankfully they go with my go-to flats of choice these days.  I'm safe, BSparl is safe, and CVS is safe because they will continue to get my money.

So what's sexier than compression stockings?

Nothing.

Because without these blasted old lady leg warmers, I'd be risking a blood clot and varicose veins, thank you very much.

January 13, 2010

JDRF, Animas, and Dexcom Walk Into a Bar: Not a Diabetes Joke - An Artificial Pancreas.

Okay, so it's not a joke.  And it's not a bar.  But the JDRF, Animas, and DexCom have walked into a momumental agreement in efforts to create an artificial pancreas.

According to the press release, "The Juvenile Diabetes Research Foundation today announced an innovative partnership with Animas Corporation to develop an automated system to help people with type 1 diabetes better control their disease – the first step on the path to what would be among the most revolutionary advancements in treating type 1 diabetes: the development of an artificial pancreas, a fully automated system to dispense insulin to patients based on real-time changes in blood sugar levels."  

Alan Lewis, PhD, President and Chief Executive Officer of JDRF, is quoted in the release as saying, "JDRF will provide $8 million in funding over the next three years for this project, with a target of having a first-generation system ready for regulatory review within the next four or so years.” 

So what exactly would it mean to have an artificial pancreas?  More from the release:  “If successful, the development of this first-generation system would begin the process of automating how people with diabetes manage their blood sugar,” said Alan Lewis, PhD, President and Chief Executive Officer of JDRF.  'Ultimately, an artificial pancreas will deliver insulin as needed, minute-by-minute, throughout the day to maintain blood sugars within a target range.  But even this early system could bring dramatic changes in the quality of life for the 3 million people in the U.S. with type 1 diabetes, beginning to free kids and adults from testing, calculating and treating themselves throughout the day.'”  

Also, "DexCom, Inc., a leading manufacturer of CGM devices, will supply the CGM technology for the system to be developed by JDRF and Animas." 

I think this is a huge step forward for a new way of treating type 1 diabetes.  I've clocked over 204,360 hours with type 1 diabetes since my diagnosis over two decades ago, I've seen so many tremendous technological steps forward in treatment options for type 1.  Home glucose testing machines were "all the rage" when I was diagnosed, and there were only two or three insulin options for injection therapy.  Now, home meters are the norm, there are more insulin options and more insulin delivery options now than ever before, and continuous glucose monitors are part of my regular routine (versus before, if you had mentioned them to me as a kid, I would have thought you were from the moon). 

And now we're talking about an artificial pancreas?  A real one?  One that actually could be used in my lifetime, before I'm too old to care or too sick to benefit from it?  I believe this can happen, and I am so hopeful that these organizations and companies can make this a reality.

A cure is something I don't think much about.  It's something my heart has protectively hardened me against hoping for.  I know that reversing my body's inclination to attack its own islet cells could be a long time in coming.  What I do know is that I've been living with type 1 diabetes for almost my entire life, and I've battled hard to keep my body healthy and strong.  And now, I'm expecting a baby and have even more incentive to stay healthy for my child, so that I can be part of her life for a long, long time.  

If an artificial pancreas can help me minimize highs and lows in my blood sugars, that could help to protect my body from diabetes-related complications.  I could be safer.  My body could feel more "normal."  And my baby has a better chance of having me see her children born some day.

This press release has given me a reason to grin today.  And I'm excited to see how far these organizations can bring us all towards a better life with type 1 diabetes.

December 10, 2009

A Tour of the Contour USB Meter.

Every meter I have used over the last five years or so has been relatively similar - small, compact design, color options for the casing, and good lancing devices.  (Don't go too far back in my memory bank, or you will find The Harpoon!) 

But what I have been struggling with, as an adult with diabetes, is the whole logging thing.  With BSparl on board, my mission is more focused, but before this pregnancy, logging was something I only did the night before I went to the endocrinologists office.  It wasn't a streamlined part of my day, so it was tough to keep up with.

Today, I tried out a new meter called the Bayer Contour USB meter (pretty self-explanatory name there, no?) and in the interests of full disclosure, Bayer's PR company sent me this meter, and the accompanying 25 test strips, for free so that I could review the meter.  

These days, my life is moving quickly and without warning, so the idea of a long, drawn-out review seems to fly in the face of this quick, zippy little meter.  So here are my impressions of the Contour USB meter, in snapshots:

Plugged into the Macbook.

Wow, it looks like a USB flash drive, all plugged into the computer and whatnot.

Is this what was missing from my childhood?

OOOOOH!  Look at the pretty lancet colors!  Who would have thought that a purple or aquamarine lancet would actually bring me joy?

APPLY BLOOD.  Damnit!

The lancing device was easy to use, but didn't give me a blood sample until I poked myself three or four times.  Hard to tell if that's the device or my calloused finger tips that are at fault.  But once I was ready to apply the blood, the full-color screen was happy to accept.

Aftah my meal.

And after three seconds, my post-breakfast result came back.  (A little on the higher side, but oatmeal is a tough one for me!)

The meter has options to set your personal blood sugar goals, with a little icon of either an apple or a devoured apple to show the numbers as pre- and post-meal.  It is set up to provide 14 day averages and a built-in logbook, and just before you apply the blood sample, it gives you an option to designate the number as pre-meal or post-meal. 

There is software built into the meter, but I haven't had a chance to check it out yet.  (I'm hoping it works with my Macbook, otherwise I'm going to have to toggle back and forth between my PC and the Mac to get a feel for this thing.)  I'm planning to check this meter against my other meters, for both accuracy and convenience, but for a person like me who relies on insurance coverage and co-pays to provide diabetes supplies, it's tough to consider switching meters when I'm both happy with my One Touch and also completely covered by my insurance company for One Touch strips.  Options from different companies are great - especially when companies are putting out meters that are cool, like this USB one - but it would also be great if insurance companies would allow coverage shifts just as easily. 

Overall, the USB meter is pretty darn easy to use, is nice to look at, and is tiny.  I like having the option to plug it right into my computer (yes, there is a wall jack, in case you don't have a computer handy when the meter needs to charge) and I also really liked the full-color screen.  But I'd have to use it for a few weeks, and subject it to the torture chamber that is my purse, to see how it really stands up.

Has anyone else given this meter a go?

November 23, 2009

Diabetes Torture Devices.

Last week, on Twitter, Elizabeth Arnold posted a link to a photo that made my whole body cringe and I instinctively said, "Oh crap, THAT thing?" (I'm stealing and reposting this photo here, but the original photo credit belongs to Cardinal Health.) 

Behold - The Guillotine:

The Guillotine:  Worst Lancing Device EVER

This photo made me shudder because I remember this lancing device clearly.  It was the first one I ever used, outside of having my finger pricked by the nurses with the lancet alone, and I remember the shunk sound it made as it came careening towards my fingertip.  It wasn't the standard shunk we know now - this sucker would have to be cocked back like a rifle, and once it clicked loudly into place, you had to hit that button on the back to release the spring-loaded lancet.  And it wasn't just spring-loaded - The Guillotine had an agenda.  It would come screaming over the top of the curve and embed itself into your fingertip, and it was all my mother could do to keep my hand pressed against that little plastic circle at the bottom there. 

I hated it.  It scared the crap out of me, and even though more humane lancing devices were introduced soon after my diagnosis, The Guillotine lived in our house much longer than I'd care to admit.  Even the lancets looked like little harpoons. 

Back in 1986, diabetes technology wasn't completely archaic (I was dx'd after disposable syringes were used, and way after pumps were the size of backpacks), but it wasn't comfortable in the slightest for a second grader.  That Guillotine still makes me cringe, even 23 years later, and I'm increasingly thankful for every little advancement we've seen over the last two decades.  

Because I mean, really.  Look at that thing.  OUCH!!

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]

November 03, 2009

Lovenox, Heparin, and WTF.

What the hell am I supposed to take?During my endocrinologist appointment last week, I brought up that itchy, scratchy Lovenox rash to my OB/GYN, Dr. T.  And she wasn’t comfortable with how my body reacted.  

“That rash is from two weeks ago?  How does it feel now?”

“Less itchy, that’s for sure.  But it got all hivey and wouldn’t relax, not for about a week.  It itched like mad.”

“I don’t like that.  I don’t want you to continue to take Lovenox, especially if it gave you that reaction.  Who knows how bad the reaction could be the next time?  I want to switch you to something else.”  She started to write on my chart.  “Heparin could be another alternative for you.”

“Okay, what’s the difference?”

She told me that both Lovenox and Heparin are large-molecule drugs that don’t pass into the placenta, so Bsparl is safe, and also that they both serve the same purpose:  to protect me and my baby from blood clots (the risk of which increases with both Factor V and pregnancy).  

But you guys know how I am by now.  I feel weird taking extra drugs, and I’m very conservative about adding more and more Rxs to my daily routine.  Also, consulting with Dr. Google brings me all this scary information about how Heparin is a category C drug, meaning it could have effects on the baby.  I don't know what's what, but I do know that I need to trust my doctor and her years of experience over a Google search.  (Right now, I'm wondering if I can bypass these drugs altogether and just work out in the airplane bathroom for the whole flight.  Kidding.  Sort of.)

Yet I still find myeslf feeling uneasy, and looking to see if any of you have had personal experience with Heparin.  I'm very WTF about this and confused as can be.  Right now, I’m only on insulin, pre-natal vitamins, and blood pressure meds (don’t worry – safe for baby), but according to Dr. T, I’ll be taking something to help protect me from clots for six weeks after BSparl is born.  (Great.)  So now is a good time to figure out what works best for me.

Once again, I’m clueless about what to expect.  I’m sorry to keep pestering you guys with all these questions, but when it comes to anything other than insulin, I’m lost.  When I wrote about Lovenox before, you guys were invaluable and I learned a ton (even brought some of it up to my doctor).  Now I’m asking once more – has anyone ever taken Heparin?  Any weird, itchy side effects?  Any burning at the injection site?  Any … anything?  

(And BSparl says hi.  He just sent a messenger pigeon to me from the womb.  He is baking cookies in there.  Busy little peanut.)

October 22, 2009

Diabetes, Lovenox, and Bathroom Jane Fonda.

The flight to Las Vegas from Boston is a long one – six hours on the way there and five on the way back.  I talked with my doctors before taking the flight, and being pregnant, I’m dealing with an increased threat of deep vein thrombosis.  The Factor V Leiden gene in my body is also a red flag, so these longs flights caused some concern for my medical team.

“We’re not worried so much as we have some rules for when you’re flying. The first is that you need to get up and move around about once every hour to keep your circulation steady and your legs moving.  And the second thing is that we’d like you to take Lovenox on the days that you’re flying.  That will help combat the Factor V risk.”

Take a shot?  No problem.  At least that’s one thing I can commit to without fear.

So about an hour and a half before my flights took off, I snuck into the airport bathroom and pulled out the pre-filled syringe of Lovenox.  Lovenox is an anti-coagulant drug that helps to prevent blood clots.  I don’t know much about it, other that it’s safe for pregnant women to take and it was one of the conditions set forth by Joslin, so I pretty much do what they say these days.  I’ve never taken anything like it before, so Wednesday evening was my first time.

Fellow diabetics, I just need to say that we have it good with our teeny, ultra-fine needles.  This Lovenox needle was clumsy, long, and thick.  “Inject it right into your abdomen, where you’d normally take an insulin injection,” the doctors recommended, so I did just that.  But it sucked a little bit.  One of the side effects of the injection is bruising and soreness, and they’re not kidding.  Within 15 minutes of taking the injection, a deep red thumbprint popped up on my abdomen, tender to the touch.  

But that seems to be the only side-effect I’ve experienced.  Except for a little bit of paranoia.  And now, a few days after the trip, I have the itchiest, red rash at my injection sites. 

Once a doctor tells me that I could be at risk for something, I do what I can to help mitigate that risk.  For these flights to Las Vegas, I took the Lovenox injections and made sure I was up and about once an hour, but I also did something else.

Every time I went into the airplane bathroom, I did some weird kind of calisthenics.  Thanks to BabySparl, the need to pee is hourly (making me test my blood sugar all the time, wondering, “Is this because of Baby or am I high?), so I’d use the ladies’ room and then face the mirror.  And then do this bizarre mix of high knee raises, running in place, and stretching.  Thankfully, being barely 5’4” gives me enough room to move around in there, but I felt like a tool.

“And stretch!  And stretch!”  I heard Jane Fonda in my head as I faux-exercised in the airplane bathroom.   

I prayed that the stewardesses couldn’t hear me thrashing around in there.  How the hell would I explain that?  “I don’t want a blood clot so I’m doing a little dance here in the bathroom.  That's legal, right?”

The itchy frigging rash from the Lovenox injections.
 
The flights were fine.  (If you don’t count the flight from Boston to Las Vegas, which included an extra hour on the trip due to a strong headwind, expired food, not enough meals for passengers, no movie, and no working radios.  US Airways, you sucked it up on that one.)  Lovenox was a success.  And now I feel like I’ve managed to fit in a workout, even at 35,000 feet.  But I’m curious to know if anyone else has ever taken Lovenox, or another kind of anti-coagulant.  And if anyone has ANY tips at all on dealing with this frigging itchy rash.  It's starting to go away, and I know it's just part of the side-effect fun, but it's making me scratchy-crazy. 

It’s all new to me, and I’d appreciate any feedback from someone who’s been there.  (And if you have airplane exercise tips, share those, too.  I’m heading to Florida in two weeks and am wondering how I’m going to embarrass myself on that plane, too!)

October 08, 2009

Needed More Diabetes Real Estate.

Wearing two diabetes devices has its mental hurdles, but sometimes the physical hurdles are the most irritating.  For the last two weeks, my husband and I have been packing up our old apartment and I've been closing out my office at dLife, so there's been a lot of physical lifting and moving of stuff.

Which means there's been a lot of Dexcom and insulin pump site set jostling.  Wearing the Dex and the pump full-time means plenty of little red dots on my thighs and lower back, and the physical movement of moving has made these areas even more irritating and inflamed.  

What's my point?  

My point is that my regular sites are sore.  And I need to switch things up a bit.  Again.  So last night, I opted for an arm site for my infusion set, instead of my standard thigh or hips.  I've worn the site here before, and it was comfortable, but it can be a hassle wrangling the tubing and shirts/bras. 

Needed some new diabetes real estate, you know?

So this round, I opted to use the longer tubing (43 inches) and I'm snaking that up my arm, down under the back of my bra, and then down to my hips where the pump clips to my pants.  The longer tubing gives me just enough room to accidentally pull on the tubing without jerking the site out.

It is a very different place for me to wear it, though.  So I reminded Chris to remind me.

"Dude, I'm showing you in case I forget.  The site is on my arm, okay?"

"Got it."

Now, as I sit here and write this, I can't feel the wire and it's undetectable underneath my long-sleeved shirt.  Hopefully wearing the site on my arm for a few days will help my other sites heal and give me a little breathing room on the ol' real estate front!

August 27, 2009

Pink is the New Quickset?

Even though I've been pumping for several years, I've only used one kind of infusion set in that whole span of time.  So last night was a diabetes first for me - my first Inset infusion set.  

My first thought was, "Um, big needle?  What's that about?"  But it's just a mega needle for filling the pump reservoir.  The infusion sets are luer lock (which I'm not sure is one word or two or what it means other than some version of "it's like a bottle cap"), which means that using the new sets means using new reservoirs.  I'm not sure how I feel about this, but I think I could adjust.

Mega needle?  No big deal.  It's not going in me. :)

In addition to the funky reservoirs, the Insets come with their own built-in insertion device.  This is a big score for someone like me, who travels a lot and is always having that mid-drive home to RI panic attack of "OMG IS THE QUICKSERTER IN MY BAG?!"  With the tubing coiled around the infusion set there, it's a little complicated (or at least it was for me, this first time) to prime the pump and pull away the adhesive cover.

Pink.  I can't believe I'm using a pink set and am OKAY with that.

But the fact that it cocks back and becomes its own insertion device?  I'm sorry - that's just downright badass to me.  (It also slightly resembles a birthday cake, but that's neither here nor there.) 

Birthday cake, anyone?

One thing I didn't realize until I had attached the site was that it was pink.  Pink, pink, girly pink.  "Chris, it's pink!"  And he took a peek.  "It's cute.  I like it." 

Another change for me to get used to was the fact that this set doesn't connect to the tubing by swiveling in place.  It snaps together like a seatbelt.  It isn't as low-profile as the Quickset hub, but it's pretty close.  But I was weirded out by one thing:

"Where is the pump cap?"

I'm used to that little plastic disc that covers my set when I'm showering or in the ocean or during intimacy.  How does this new infusion set stay "closed" even when I'm disconnected?  Does anyone know?  Or it is just supposed to be open like that? 

All hooked up on the left thigh.

One thing is for certain:  this kind of infusion set does produce less garbage.  Here's the aftermath from a site change with the new infusion set: 

More diabetes carnage.

I like that the set can close all on it's own and be chucked into the sharps container.  And I also kind of like the spaceship look of the infusion "pod."  Actually, I just like trying something new for a change. 

The disease doesn't change.  Diabetes is every day and it's the same kind of crap every day.  But a little technology swap or a different flavor of juice to treat a low or a new kind of workout at the gym to mix up my routine?  Sometimes you just have to appreciate these little bits of change. 

(Also:  You guys are great.  GREAT.  You had so much great feedback on yesterday's post that I really feel like I have the right questions to ask my endo this week.  THANK YOU for all of your informative comments!!) 

July 08, 2009

Diabetes ... is a Game?

The idea of creating a game about diabetes both intrigues me and creeps me out a little bit.  Diabetes is a game? I guess after an evening of "WHY 200?  WHY?!!" I'm not feeling so light and fluffy about diabetes.  But I see the potential for kids to learn about diabetes and its management through the use of games, so I'm all so for whatever gets good information out there.  And over the last few days, I've come across two particularly interesting games, thanks to reader alerts, aimed at kids who either have diabetes or have friends with diabetes.

The first game is on the Nobel Prize educational games site and it's cleverly called The Diabetic Dog game.  (Wee bit short on imagination once they got to the naming part, I suppose.)  I will admit - I played this game for at least 15 minutes and I appreciated the cuteness of the doggy. 

The Diabetic Dog Game

As a "caretaker," I was instructed to keep my diabetic doggy (named, in my profile, "DoggyPants") happy (by petting him), well-fed (by purchasing food for him), getting him to exercise (by walking him), and keeping his blood sugar in check by giving him insulin injections.  Keeping an eye on the bar at the bottom left of my screen let me know what DoggyPants's blood sugar was, and I could feed and dose him accordingly.

(Sidenote:  Having that bar gauge with his blood sugar in it sure helped me figure out what I was doing, and I wondered if the developers of this Diabetic Dog Game realized how they're helping further the case for continuous glucose monitors.) 

Overall, I liked how this game showed the importance of insulin, food choices, and exercise as the cornerstones for good diabetes management, and it didn't tout insulin as "a cure."  Basically, all you do is chase this little puppy around and feed him or dose him or walk him.  Constant cycle of redundancy, only the results aren't predictable.  Kind of like real life.  :)  

The other game I have been receiving reader alerts on is the Didget from Bayer.  I haven't seen this game in person, but according to the word on the street (read: their website), "The Didget blood glucose meter from Bayer is the only meter that plugs into a Nintendo DS or Nintendo DS Lite gaming system to reward children for consistent testing."  

The DIDGET.  IN ALL CAPS!

So it's an actual meter that snaps into the Nintendo system.  (It appears to be, or be completely identical to, the former "GlucoBoy" from a bit ago.)  Honestly, that is pretty darn cool, and I wish that kind of "fun" was available when I was testing my blood sugar as a kid.  Hell, I'd like to have that kind of positive reinforcement NOW, thank you very much.  

"This unique meter helps encourage consistent testing with reward points that children can use to buy items within the game and unlock new game levels. And, since the DIDGET meter is based on Bayer’s trusted CONTOUR™ system, you know you’re getting a meter that’s reliable." They are also building a community for kids to "hang out in" virtually, comparing notes.  Of course, since it's Bayer, they need to slide in their personal product endorsement, but they have the right idea.  Test often, get rewarded for keeping tabs on your numbers, and maybe Nick Jonas will show up at your house and give you a hug.

That last part?  A lie.  But Bayer is working its way into the hearts of kids with diabetes, and as a former kid with diabetes myself, I would have appreciated that kind of innovation as part of my childhood with this disease.  From what I can tell so far, this meter is being marketed towards diabetics in the UK, but hopefully there will be a United States counterpart.  With mg/dl readings.  Because doing conversions when low?  Not so easy.

So there you have it. We've come a long way from that game with the elephants or the other one about the Escape from Diab, and hopefully more efforts will be made to engage kids - and adults! - with diabetes.  Positive reinforcement is hard to come by in this whole diabetes mess, so every little bit helps.

July 07, 2009

diaTribe Giveaway: Dexcom!

I wanted to let you guys know about this Dexcom opportunity, courtesy of the team at diaTribe.  Here are the details, in editor Kelly Close's own words:

"For this month, DexCom has given diaTribe a $500 credit for any DexCom merchandise, which we will give to one lucky reader! Visit www.diatribe.us/dexcomgiveaway to enter the drawing. Like all of our giveaways, this is open to non-readers as well--help us spread the word about CGM."

I'm all for anything that helps get more CGMs in the hands of people with diabetes, and I'm also a fan of the mission of diaTribe.  So now you know.  And knowing is ... you know.  Half the battle.  (I was also unaware that there was a G.I. Joe character called "Barbecue.")

Disclosures aplenty on this one:  I'm a columnist for diaTribe and I'm involved in a sponsorship agreement with Dexcom.  I have type 1 diabetes and I also know how to crochet.  Any and all questions can be directed to me.  Or Siah, but you'll have a better chance of getting a response from me.

July 02, 2009

One Lump or Two?

Like I wrote a few weeks ago, "Even though I do not like the disease, there are some diabetes-related simple pleasures that make me smile." 

But on the flip side of that, there are some diabetes-related things that make me grimace.  (Not Grimace, but grimace.)  And when I'm feeling down about the hard parts of managing this disease, I often turn to humor to lift me back up.  (For me, a little gallows humor goes a long way in keeping me from really falling into a depressive state.  It seems like a counterproductive idea, but it really helps me.)

This is where Haidee Soule Merritt's book comes in:  One Lump or Two?  Her book more than resonated for a 20+ year diabetes veteran like myself.  It's taken me a long time to build up this much amusement at a disease that's trying its hardest to take me out, but now I'm in the thick of the smirking-despite-the-chaos.  

As I read through her book, I laughed.  I laughed and nodded my head in agreement, thinking, "Oh hell yes, I hate those geyser fingerpricks."

How many times has this happened to you??
Who hasn't this happened to?  (Image credit:  Haidee Soule Merritt)
 
I snicked despite trying to be classy when I saw the one about low blood sugars after sex.  (Trust me, not fun.  And also, awkward as hell.)  

Low blood sugar after sex.  Oy.
Been there.  Done that. (Image credit:  Haidee Soule Merritt)

Diabetes isn't easy.  Neither is laughing at it.  But laughter, finding something that alleviates some of the anxiety and fear that comes with a chronic illness, can make such a huge difference in health.

If you want to order your own copy of Haidee's book, visit her website (and enjoy the duck sounds on the buttons, because they quacked me up).  As you thumb through your copy of One Lump or Two?, you'll find yourself smirking with understanding, too.    

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 14, 2009

I'm Sorry ... Glucose Spray?

Tuesday night's meeting did more than introduce me to some fantastic fellow type 1s ... I was also ushered into the wonderful world of glucose spray.

I know.  My face made that "Excuse me?" look, too.

One of the women at the meeting, Christina, was talking about her low blood sugar treatment methods and then she whipped out this little bottle of what looked like my dad's binaca spray

My world was once just glucose tabs.  And then they juiced 'em up and developed liquid glucose shots.  And gels.  (I love the gels, to be honest.)  But spray?  A glucose spray?  That was new to me.

So I took a picture of it, for posterity.  

The mystical, magical glucose spray.
 
(Hand model is Karen, because if I took a picture of my rotten hands, you'd force me back into my gingerbread house to wait for Hansel.  And not the other Hansel, even though he's so hot right now.)
 

According to myth, and what was written on the back of the bottle, you spray this stuff into your mouth and it absorbs into your cheeks.  The bottle says five sprays, but Christina dismissed that recommendation with a distracted wave.  "You need like 10 or 15 sprays, honestly."  

I seriously thought this was the coolest thing.  Because I'm skeptical about anything that involves "change," I'm wary of its effectiveness, but I'm so curious to see if it would work as fast as my beloved juice. I have never seen this in my local CVS, but their website lists it as available in Rite Aid, Wal-Mart, and several online distributors.  And I haven't tried it yet, but I think I'm going to have to. 

Just to satisfy my own curiosity.    

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]

May 06, 2009

Diabetes Treat: Sugar-Free Popsicles.

Free foods pretty much ruled my freaking world when I was a kid.  Sugar-free Jell-O, pickles, cucumbers, and sugar-free popsicles were stashed in mass quantities in my childhood home, so that my prying little diabetic hands would hopefully land on a popsicle instead of an "E.L. Fudge" cookie. 

(Note to Michelle:  Your comment a few weeks back about El Fudge the Zorro Cookie still tops my list as one of the funniest comments of all time.)

And even though I'm a grown-up diabetic these days, the disease remains the same.  So does my struggle with food.  Now it's up to me to keep my kitchen stocked with tasty sugar-free treats. 

But some things are a little bit different than they were twenty years ago.  For instance, Chris and I are very wary of sugar substitutes and even though I use Equal in my coffee every morning, I'd prefer a non-chemical alternative.  We try to eat as healthy as possible and buy organic whenever we can (even though it's freaking pricey to buy anything in Fairfield County, where they charge $3.00 for an iced coffee without batting an eye), but avoiding those sugar substitutes is really a challenge for me.  I'm used to Equal and it's mega-sweetness, and other natural alternatives don't pack the same punch.   So we don't always take the organic, attempting-to-be-healthy highroad, and often times we find the grocery cart packed with sugar-free popsicles and Jell-O and other "safe for diabetics but just ignore these chemicals" items.

Because it's hard to find crap I can eat that doesn't make my numbers go berserk and isn't packed with chemicals!

/rant   

Delicious.  Not quite nutritious, though.

I'm a sucker for a good popsicle.  (And for a good pun.) I'll even eat the orange ones, even though they get a bad reputation for some reason.  (Why do you eat the grape ones first, Chris?  What do you have against the orange?)  Popsicles are my favorite method of staying hydrated when my blood sugars get all teeth-sweaters high, and Chris can often tell if I'm working through a high by the number of popsicle wrappers that collect on the coffee table.  And the effects on my numbers are so minimal that I can eat three in a row without a blip on the Dexcom.

Free foods.  I love 'em.  I appreciate 'em.  And when I get all snacky in an unruly way, I need 'em.

What kinds of free foods are you guys snacking on?  

March 27, 2009

Diabetes Carnage.

I know my daily diabetes stuff produces a lot of waste, like the test strip I use every time I prick my finger and all the packaging that comes along with each disposable insulin pump infusion set. 

But it wasn't until I changed my pump and my Dexcom sensor at once that I realized how much carnage I leave in my management wake.  

Exhibit C (for crap, holy):

So.  Much.  Stuff!

If you scoot over to Flickr, you can see each item flagged in the photo, but the basic gist is that two small bits of technology attached to my body creates a lot of waste.  (The Blackberry is in the photo purely because I forgot to move it.  It isn't related to diabetes management.  Then again, with the number of emails I'm sending from that thing on an hourly basis on the climb, maybe it is.  Digression?  Yup.)

Other PWDs and parents of PWDs (POPWD?) have talked about the insane amount of diabetes-related garbage before, but this one night really showed me how so little goes such a long way - and not in a great way.  And with Earth Day coming up at the end of April, I'm extra-aware of the mess I make sometimes.  Do you guys put your stuff in a sharps container, or do you throw these things out?  I used to be so good about clipping syringe tips and filling those coffee cans and taping them shut with electrical tape, but the last few years have produced medical waste that doesn't look as "druggy" as the orange-capped syringes of my past diabetes life.  ;)

Once, in college, we had a party and threw out a lot of beer cans.  (There were seven of us in one house, okay?)  During the night, animals got into our garbage and we woke up to beer cans and - oh crap - syringes all over the front lawn.  I.  Was.  Mortified and have been paranoid ever since.  How do you guys dispose of your diabetes carnage?  I need some tips, because I'm getting sloppy.

(Also also, SUM may have some downtime this weekend, as I'm moving some web bits around.  So if you stop by over the weekend and hit a 404 or 500 error, please be patient.  I should be back up by Monday morning.  Thanks, and have a good weekend!)

March 26, 2009

True2Go Meter - It's THAT Small.

It's kind of like Review Week here at SUM, because I have a lot of diabetes-related products and goodies that I've received over the past few weeks and wanted to talk about here.

One of the items I received was this teeny True2Go meter.  Pictured heeyah:

True2Go - wicked tiny.

I am usually very good about making sure I have my on me at all times, successful mainly because I always carry a purse (even in the woods) and I am usually the group "pack mule" for any event.  Very rarely do I forget my meter, but it has happened. 

(I realize I've just tempted fate to have me leave my meter behind sometime in the near future.  Fate, please forget I said that.)

This little True2Go meter is super small, and with the meter attached to the actual bottle of strips, it's very easy to stash anywhere.  Glove compartment, desk drawer at work, mother-in-law's house, shoved into that extremely small beaded purse that your license barely fits into - teeny meter may do the job.

It seems to be reasonably accurate, and by "accurate," I mean it was just a few points off from my OneTouch UltraLink and in tune with my Dexcom graph.  For a meter the size of a silver dollar, the display is decent.  It took longer to show my result than I'm used to, but it eventually popped up on the screen after 15 seconds or so, I think.  

For true travel convenience, I could just throw a lancet into the strip bottle and be emergency-ready.  I used my OneTouch lancing device for most of my tests, though.

Having different meters is nice, for convenience, but the main drawback is that most insurance companies only cover one kind of test strip.  For me, my insurance covers my Lifescan strips, but they aren't hip to covering a second brand.  I have used a Lifescan meter for several years now, but I wonder how much of that is due to the fact that I have a stash of strips already, whereas I don't have any more of these little True2Go strips.

Points to ponder.  But this meter definitely gets high marks on size and portability, and I daresay it's a bit cute. 

For a few photos with the meter in a size comparison pose-down with my UltraLink and the ubiquitous quarter, scope out Flickr.

March 25, 2009

Smiths Medical Pulls Out from Diabetes Market.

Farewell, Cozmo.Wow - this surprised me. 

The company that makes the Deltec Cozmo pump issued a statement today, saying that they are stopping the sale of their insulin pump.  According to the press release

“The continued health of the thousands of people who use the Deltec Cozmo® insulin pump is our primary concern, and they should be reassured that their pump remains an excellent choice to help them manage their diabetes,” said Srini Seshadri, president of Smiths Medical. “Our customers also should be reassured that Smiths Medical will meet all of its warranty obligations; provide customer and clinical support for the lifetime of the warranty of all pumps; ensure that Deltec Cozmo® insulin pump cartridges and Cleo® and Comfort® infusion sets are available; and make any necessary transitions as simple as possible.”

Why did they pull out? Looks like the pump "biggies" - Medtronic and Johnson & Johnson - have cornered the market share.  More from the release:

"In addition, as its only direct-to-consumer enterprise, the Diabetes business has little synergy with the rest of Smiths Medical’s businesses. For this reason, Diabetes requires its own extensive sales, marketing, reimbursement, insurance and clinical support infrastructure in the United States, which has resulted in it becoming uneconomical as sales and profits for the business have decreased. Without a strong, profitable Diabetes business in the United States, the world's largest medical market, it would also be impossible to sustain the business internationally.

Looks like the full transition out will take about four years, which corresponds to the warranty on new insulin pumps.  Cozmo pumpers, at that time, will need to chat up their medical team to get information on switching to a new insulin pump.  They have a whole website dedicated to answering questions, so if you need more information, check out the site.

Personally, I'm sad to see this happening.  I think having more pump manufacturers contributes to more innovation, offering diversity to insulin pumpers.  I'm a Medtronic pumper, but I considered the Cozmo back when I was shopping for a pump.  I hate seeing options removed from us.

Sorry to see you go, Cozmo.   

All-Inclusive Diabetes Software.

Do you know of any?  (See title.)Diabetes info OVERLOAD!!!

I've received a few requestions from readers about software to take all the information from our respective diabetes devices (multiple meters, continuous glucose monitors, electronic food diaries, etc, etc, etc.), and I don't have a clue where to refer people.

I know some d-folk use SugarStats and other data tracking software, but are there others?  I have a few readers who are looking for info, but quite frankly, I'd like to know, too.  :)  My logbook is being updated regularly (and blue stars are being steadily applied to my calendar), but to have an all-in-one system that can integrate all of my various diabetes info moments would be awesome.   

if you have any ideas, please share them! 

Update:  Someone emailed me about Project Diabetes - which has an iPhone app and everything.   Another person mentioned the Track3 device (which I will be reviewing later in the week/next week) for tracking.  If you're using this, let us know how it works for you!

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 18, 2009

Knot What I Expected.

I have to admit - I'm pretty satisfied with this longer tubing option.  Maybe I'll be more annoyed in the summer when I'm sporting fitted clothes and no trouser socks, but for those freaking freezing months with bundly sweaters and long pants, I'm content to have an extra 20" of tubing. 

Thing is, I tend to get tangled in it when I take off the pump.  I guess I bunch the tubing together and just shove it in the waistband of my pants or, if I'm rocking the sock, it stays smooth as it travels down from my hip to my ankle.  But when I disconnect to shower or go to the gym, the tubing becomes a knot of chaos.

Exhibit A:

Knot a clever caption, either.

How did this happen?  It was on the bureau for exactly 20 minutes - just for a shower! - and when I went to snap it back into place, the whole damn thing was knitted into this insuiln pretzel.

(Should I mention that it also was wrapped around me, and Prussia the Cat, this morning?  I woke up to find the cat pressed against my side and the pump tubing casually looped around her paws.  Thank goodness she didn't pull a Sausage and bite through the thing.) 

It's weird to look into my diabetes supply closet and mentally map out my tubing options.  Now that the weather is starting to warm up a smidge, I'm thinking about packing up my winter coats and my wool skirts in exchange for my spring sweaters and dresses.  Long tubing works well for using the sock trick with a lower back infusion set, but it could be a pain in the everything when it comes to tucking tubing in a springy warp dress.  I'm planning to switch back to the 23" tubing in a few weeks.

I can't wait until the weather is warm again.  I've had a freaking-nuff of the snowy stuff.

March 16, 2009

The "Ellipmachine."

The Ellipmachine ... by Mennen.When I was preparing for our wedding last year, I spent a lot of time at the gym.  A.  Lot.  As in, too much.  If I wasn't at work at dLife or doing wedding-esque things like cake tastings, dress fittings, and bridal shower fun, I was working out and doing my best to keep the stress from fattening me up.

Fitness was my priority.  

But after the wedding, other stuff started to crop up.  Weekends home in RI.  Travel for work.  Writing projects that required lots of attention.  New focuses at dLife.  Every day was this whirlwind of chaos and while I've been having fun and being very productive, my days at the gym were harder to come by.  Before, I was working out faithfully Monday - Friday after work.  But "life stuff" kept cropping up, and suddenly I found myself at the gym only four days a week.

Then it all became a perfect storm of distraction.  I was working late on dLife initiatives.  I was answering emails from my Blackberry into the wee hours of the night and sleeping less.  My wrist exploded in a fit of tendinitis and low blood sugars returned to my life with a renewed sense of determination.  Piles of snow kept falling and the gym kept closing, and on other days, I worked too late to get to the gym before it closed.

My time at the gym went from frequent and intense to only four days a week and pretty remedial.

Not okay, because my body wants to be fluffy.  It may be a family gene pool thing and it might also be exacerbated by diabetes factors, but if I sit still and let nature take its course, my body wants to be a happy 15 lbs heavier.

I, however, do not agree.

But I was frustrated because between feeling stressed and having lows again, my caloric intake far exceeded my burn off.  Thus, I lost any semblance of abs.  (Shame, too, because I liked them while they were there.)  So, in effort to reclaim my abs before I get pregnant and become a happy beach ball swallower, I did my part to stimulate the economy:  I bought an elliptical machine.

Or, as I keep calling it by mistake, an "ellipmachine."

It was delivered and assembled last Monday morning, and I called Chris (who was on business in California last week) to tell him it had arrived safely.  

"It's here!  The ellipmachine!"

"The what?"  

"I mean the elliptical."

It's a nice machine - very smooth and not clunky as to annoy our downstairs neighbors (I do not want to become Shoes) - and I used it every day last week for an hour.  Now I'm able to go out with my coworkers after work for an hour or two and still manage to slide a workout in.  I am also hoping to use it in the mornings (provided I'm able to get to bed at a reasonable time and eek out a 20 minute workout in the am).  My main hope is to reclaim the level of fitness I worked so hard to achieve before the wedding but lost a bit due to that pesky "life stuff."  

Last week, while Chris was out of town, he called one night and I answered, panting.  

"Hey baby ... what are you doing?"

"Dude, I'm on the ellipmachine."

I could hear him laughing.  "The ellipmachine, eh?"

"Oh you know what I mean."

Here's hoping that the ellipmachine can help me get a workout in even when my schedule wants to thwart my good intentions.  I'm ready to battle.

(Take that, early gym closings!  En garde, late nights at work!  Pffffft, snow days!  Come back, sort-of-abs!) 

March 06, 2009

Kerri's Diabetes Technology FAIL.

I've had about three solid weeks of good blood sugar control, with just one or two lows and not many excessive highs.  I celebrated regularly, because this kind of even keel isn't common for me.  And because I'm in hot pursuit of a lower A1C.

So you can imagine my frustration when I had a 400+ blood sugar with no detectable cause - until I realized the pump tubing hadn't clicked into place properly after my shower.  (Something about the sweaters on my teeth and the fact that I was falling asleep face-first into my laptop didn't tip me off, apparently.   I had to wait until the realization of "Hey, haven't you peed three times in an hour?" hit me in full.)

Kerri + Diabetes Technology = FAIL.

(And also, be on the lookout for "fox paws." You'll see what I mean.)

February 25, 2009

Diabetes Snake Oil.

Snake oil - he haz it.There is no way I’m going to name the person who contacted me, nor would I even think about linking out to their ridiculous product.  But I received an email over the weekend from a tool who I will call Peddler.

Peddler started their email to me by saying, “Hello Kerri.  You can cure diabetes.”  Then there was a link to a YouTube video.  (With instructions on how to cure me, I assumed.)  I clicked through and watched their video and did the whole “rolled eyes” routine.

I am a relatively well-educated patient.  I am by no means a doctor, but I could pretend to be one for at least 8 minutes (until someone asks me to recommend treatment options or draw blood, and then I pass out and they find out I’m a lowly editor).  False claims of a “cure” don’t sit well with me, so I decided to email Peddler back and see what kind of web he would weave.

“Dear Peddler.  I have type 1 diabetes.  I have been diabetic for over 22 years.  Are you telling me I missed a cure?  Best, Kerri.”

His response:  “Yes, it must be possible.  Although it’s not easy.  Did you watch the video?  You can try [product name] and [other product name] to cure diabetes type 1?  The [product 2] keeps my blood sugar between 5 – 6 (European measure).  When normally it will go like a roller coaster.  It are the most advanced products ever made.  I use them myself.  You can find them here.  [Link]. “

My goodness. 

My response:  “You can cure my type 1 diabetes when no doctors at the Joslin Clinic, no researchers, etc. have that ability?  Can I stop taking insulin when taking your recommended product?  My body doesn’t have active islet cells – you can reverse this?  How much does your product cost and what is your personal involvement?”

Peddler’s response:  “No sure, you can’t stop taking insulin.  But if you take the product it might reverse it over time.  I have absolutely no involvement into this.  I just use it myself.  Have been looking for years to try and find a cure myself.  But you must read the information and watch the video.  But there are a lot of products and research outside of the conventional research.”

Then Peddler loses it a little bit, emailing again:  “[Another guy’s name], the health ranger, healed himself of type 2 diabetes through dieet and supplements.  You can read a lot of information on [website].  Do you know anything about farmaceutical companies and their research?  They only want to make money.  They cannot use natural vitamins and minerals because they cannot pattent them.  It’s a big money industry.  I was a shareholder, been very active on the stock market.  I know a lot about these companies.  It’s just like the oil industry.”

The snake oil industry that wants in on my “dieet” and “pattents” and “farmaceuticals?”  And what the hell is a "health ranger?"

I emailed him back:  “It will reverse my need for insulin?  Type 1 diabetes means my insulin-producing cells were attacked by my own immune system.  This product can reverse my own auto immunity?  I am shocked.  Are you involved with this supplement company, because I have to be honest - I doubt the integrity of your intentions.”

Radio silence.  Maybe he had to call back the Mother Ship for guidance. 

Then Peddler comes back out at me.

"Ok, no I'm really not. I'm 27 years old, working in a pipe factory here in Holland. I really am not involved into this company,  I'm a person just like you."

Then he sent me YouTube clips of different people talking about the supplement, and others of people showing how a certain diet plan "cured" their diabetes.  How if I just authorized some payments from my PayPal account, I'd be right ready for a life without diabetes.  (Come on, Mr. Pipe Layer from Holland.)  After clicking around for a while, I had a good sense of how much snake oil is being peddled to people with diabetes. 

And the thought made my stomach spin.

I can't help it.  This shit makes me crazy!  Don't market your false cures to me.  Nothing I eat is going to cure me.  No amount of raw vegetables or coffee or protein powder or amino acids or special high-fiber, low carb, strapless, backless nutrition bars.  Unless you have a way to keep my immune system from taking out my body's own insulin-producing cells, do not email me.  Stop preying on people with diabetes.

And for crying out loud, use spell check, would you?  

February 18, 2009

Blood Sucking Meter.

Normal blood sugar test:  Unzip meter, put s strip in it, wait until it gives me the "Hey, apply blood now" signal, and apply a droplet of blood.

This has been the routine for years now.  

So imagine my surprise when I put in a new strip, got the go ahead, and applied a blood sample only to have the meter continue to grin at me.

This meter is so confused it must be related to the cat.

"Apply blood!"

Okay.

Blink, blink.

"Apply blood!"

Um, we tried this already.

"Hey, um ... apply blood!"

"Meter, I already did this.  Count down already, would you?"

Blink.

"You have enough blood on there.  It's good to go.  Give me a result!"

"I like ... your shoes?  Apply blood!"

"Stop.  Being.  Miserable!  Give me the number, you bastard!"

"Hey look over there - is that Rocco?  Apply blood!"

It took three different strips before one actually gave me a result.  This has never, ever happened to me before.  Mind you, on Monday night, I wasn't able to get a result from six different strips from this bottle - kept throwing "Error 5" type-messages and absolutely refused to let me in on the result. 

I switched bottles (with 14 strips left), and all I could picture was tossing actual cash into the garbage can.  Those test strips are expensive!

Can a whole bottle go rogue on you? 

January 20, 2009

New Thigh Thing?

At the JDRF Walk in Connecticut this year, I met with a woman named Joan Benz.  She was tending a table of her homemade wares:  specialty pump pouches and concealment cases.  Joan is the founder of T&J Design.

Joan is the creator of a fantastic little product called "the leg cuff," and it's the Thigh Thing 2.0, as far as I'm concerned.  I absolutely cannot STAND when I'm wearing my pump on some kind of strap around my thigh and it starts to FAIL.  Nothing is more embarrassing than walking down the sidewalk towards my office and feeling that thigh strap start to slip, then slide down towards my knee, then tumble out from under my hemline - making me look like my undergarments are falling off me as I walk. 

The leg cuff is different because it's a thicker piece of fabric and there's a lining that adds some extra grip to the whole thing.  Because it is a wider structure, it isn't as apt to slide down while you walk.  And because Joan makes these herself, specific to your measurements, the fit is precise and snug. You can get the leg cuff in black or white, which makes it pretty darn versatile.  And you know what a fan I am of keeping the pump concealed and quasi-fashionable!

And while this whole leg cuff thing is a wicked cool product, there is something else that Joan makes that really tugged at my heartstrings.  Joan creates these pump concealment pieces, ranging from the leg cuff to a more standard "pump pack."  But she also makes pump packs that are doll-sized, helping a little kid with diabetes to feel more accepted and less alone with their disease.  Each pack comes with a little cardboard, doll-sized pump.  It's just about perfect.

I think having a "diabetic doll" is crucial to that acceptance stage, growing up with diabetes.  I remember I had a Cabbage Patch Kid with blond yarn hair that I named "Carolyn," and she was diabetic.  Just like me.  Carolyn had to test before she ate.  She took "injections," and she accompanied me to many pediatric endocrinologist appointments at Joslin.  Even now, years later, I remember how Carolyn the Cabbage Patch Kid made me feel  like I was normal.  Or at least a new kind of normal.  So, to me, Joan's idea is fantastic.

If you are looking for a good "thigh thing," check out T&J Design and tell Joan I said hello!

Kerri Sparling's insulin pump ... and hands.

(Also, Joan was recently named the Outreach Coordinator for the Fairfield County JDRF Chapter - my local CT chapter - so hopefully she'll have a bigger outlet for her terrific product!  Congrats on your new position, Joan!)

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 10, 2008

Stupid Diabetes Move.

Glucose meter, home aloneMy brain hasn't been attached this week.  I overslept one morning and was late to work.  I left my wallet at home another day.  I completely blanked out on a meeting I had at work.

And yesterday, I left my meter at home by accident. 

You would think that working in a diabetes media company, with another diabetic, would have me existing in a constant state of able-to-be-bailed-out.  But no!  I went foraging for my meter around 9:30 in the morning and couldn't find it.  I dumped out the contents of my work back on the floor (making a clattering sound against the concrete, but my coworkers have since learned that I'm a disaster and they anticipate the random noise), but couldn't find that blasted black zippered case.  

"Where are you?"  I said out loud.  (Coworkers are also used to me talking to myself.  Poor coworkers.)  My meter didn't answer.  Apparently it did not hear me because it was rested quite happily on top of the basket of folded laundry in my bedroom at home.

"Hey, Howard?  Do you have an extra meter hanging around?"  Nothing like paupering for diabetes supplies to the CEO.  While he didn't have an extra meter, he did have a strip I could use in my back up Freestyle meter. 

"Do you need more than one?"  

"Nah.  I'll go home at lunch and find my meter.  No problem - thanks!"

It was a weird feeling of relief to finally test.  Not having the option of knowing my numbers made me feel uneasy.  And it was an even weirder feeling of unpreparedness.  I felt like the diabetes anti-Boy Scout.

And then Real Life took hold.  A meeting that ran late prevented me from going home for lunch, and I had to instead pop out quickly to grab a bite from the deli down the street.  Howard (and his diabetes supply stash) had to leave the office for a meeting for the rest of the afternoon.  Diabetes took a big time backseat to the rest of the day, and all of a sudden, I realized it was 3:00 in the afternoon and I hadn't tested since 9:30 in the morning.

And the Dexcom sensor fell off on Monday evening and I've yet to stick the next one back on.

I felt like I was driving blindly - nervous about eating anything with more than few carbs because I didn't want to chance the spike, reluctant to bolus because I feared not feeling the low.  Yes, I should have gone home to get my meter.  Yes, I should have been more prepared.  Yes, yes, yes, I did the self-nagging and the guilt-tripping.  But NO, I wasn't prepared.  I wasn't even remotely ready.  It was the diabetes equivalent of that dream where you are naked in you 10th grade classroom.

I've talked about this before, but there's a LOT of packing that goes along with diabetes.  A weekend home in RI is never just a bag with clothes and my toothbrush - I bring a whole backup medical kit to account for everything from pump failures to yeast infections (thank you, stash of probiotics!).  And my work desk is more than dLife papers and columns - there's a rotation of meters, infusion sets, and other diabetes supplies kicking around.  I'm always preaching about being prepared, and for the most part, I am. 

Those moments of being caught with my meter down prove why being well-stocked is the best option.  But blah blah, it's not always that easy to get it right every time.  Yesterday sucked, and I felt like a fool, and I was rewarded with a blood sugar of 300 mg/dl when I came home.

I'm off my game this week.  I think it's because I forgot to call Larry on his birthday.

December 02, 2008

FiveHumans: Curing Ignorance.

At the WDD event in NYC, there was this really nice guy who came up to me and said, "Okay, this is going to sound completely weird, but I think I know you from Facebook.  Are you Kerri?"

And this is how I met Lee Fine from FiveHumans.com. 

He was attending the World Diabetes Day event as one of the Discovery Health Ambassadors, and his words inpired the crowd.  The company slogan of FiveHumans is "Ignorance is a curable disease."  I'm so on board for that.

Lee Fine of FiveHumans at WDD

According to their website, "Dan Grunvald and Lee Fine (read Lee’s story here) first dreamed up the concept of producing t-shirts with slogans and information related to a variety of diseases, which they called Disease Tees. Their goal was to help raise awareness and provide a tangible opportunity for people to support a cause near and dear to them." 

In 1999, Lee was diagnosed with type 1 diabetes.     

Lee's diagnosis, in his own words:  "The memory of sitting in the doctor’s office reviewing my blood test results is still fresh in my mind today. I was in complete disbelief. I had never felt so alone, so vulnerable, so nervous.

Since becoming a diabetic, my life has changed significantly. At times, I’m the model patient, while at other times, I’m the guy questioning my decisions, wondering when the heck I’ll get my act together. Hey, I’m Human, and as anyone with a disease will tell you, it’s a day to day affair. One thing I have done consistently is become an advocate for my disease. Before my diagnosis I knew more about the JFK conspiracy theories than I did the difference between Type 1 and Type 2 diabetes, but through life experience I’ve become an expert on all things related to diabetes and I’m always eager to enlighten anyone who’s interested in learning."

It's remarkable to see people really taking advocacy to a higher, more tangible level. Their products are cool looking, yet they make you ask questions.  Nicole (self-proclaimed Fourth Human) contacted me a few weeks ago and offered to send me one of their diabetes t-shirts.  It arrived last week, and it is awesome.   

FiveHumans t-shirt
 One Test at a Time.  Don't we know it.

To contact FiveHumans and share your story, click this link.  And if you want to check out their clever selection of inspiring t-shirts, check out their online store.  Take note:  FiveHuman will be offering the 12 days of holiday giving starting December 1st, 2008. For 12 days they will offer a daily holiday promotion on their website.

Ignorance is a curable disease.  And by spreading the word about diabetes, we're doing our part to at least cure ignorance.  That's a change we can make today. 

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 24, 2008

Old School Insulin Storage.

Diabetes supplies used to be pretty damn tough.  And insulin storage was downright badass.

When I was in college, I was on injection therapy, taking Regular insulin and UltraLente.  Instead of my current insulin pump, I used orange capped syringes and old school insulin pens.  The insulin pens were awesome and made out of metal, making them almost bulletproof.  One afternoon, I was heading out with one of my roommates to go to class and I back up the car along the gravel driveway.  To feel a little bit of a buckle and a crunch.

"Oh for crying out loud," I muttered, wondering what I just ran over.  I opened thThe blue case.  e door, popped my head out, and rolled the car forward to reveal my insulin pen, crushed underneath the back wheel.

"Shit!  I killed the pen!"  I unbuckled and retrieved the pen from the driveway, expecting to pick up shards.

But the thing was perfectly intact, only a few scratches on from the gravel.  I was impressed.

Then there was "the blue case."  From the time I was a kid, I stored my insulin in this blue cool pack that was virtually indestructable.  It was a blue zipper case with a heavy cool pack in the middle that I'd store in the freezer at night and then stick in the bag for the duration of the following day.  This pack was dragged everywhere from the beach to school to sleep overs to the car for long road trips to airplanes to my first apartment.  And it withstood the test of time, refusing to succumb heat, cold, jostling, and being slammed in the trunk door by accident.  (I am an abusive insulin keeper, it seems.) 

Even though I've switched from injections to insulin pumping, I still have these diabetes relics from ancient times.  The blue case is under the bed somewhere, and that metal insulin pen is in the pen cup on my desk at home.  Saving these bits of diabetes memorabilia isn't just unique to my dLife - apparently, Jim Turner does it, too.

When he came to visit the office a few weeks back, he brought in this little pellet of a thing that stored his insulin vial.  "Protects it from being cracked if it falls or something." It was worn from several decades of use, but it still did its job.

Jim Turner's "insulin bullet" 

I thought it was awesome.  It was like a beer cozy for insulin.  (Cozy?  Koozi?  Kangaroo?  I have no idea.)  I have only broken a bottle of insulin once, but of course it was the last one in my stash, thus creating chaos.  Anything that protects supplies, I am a fan of.

What kinds of tools from years gone by are you still hanging on to?    

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.

October 22, 2008

Diabetes Goodie Bag.

Le Goodie Bag.  Le French.  Fronch?  Fronch fries.Over the past few weeks, I've received some terrific diabetes-related products and information from people out there who are aiming to make a difference.  Ranging from support groups to bracelets, it's time to help spread the word.  (Note:  I received all of these products as samples and have not paid for these items, nor have I been paid to talk about these items.)

This is a green dot.First off, some bracelets from Lauren's Hope came in the mail.  I had a bit of an addiction to beaded medical alert bracelets a few years ago, and this care package seems to have reignited my love for something diabetes-related and delicate.  The beaded samples were beautiful (pictures coming on Flickr later today) and there was also a very cool waterproof/adjustable/washable bracelet that would be great for active little kids ... or active grown ups.  :)  If you are looking for some medical alert jewelry options that are a little different and fun, check out Lauren's Hope.

This is a green dot.I also received a sample from Stephanie Cion at WellAlarm, and she was kind enough to answer a few questions about their unique service (interview will be posted later next week).  The charm itself is sleek and classy looking, and has a sophisticated look, considering it's intended for medical use.  There is a PIN on the back of the charm that, if someone called the number and punched in the code, they'd have access to my medical information. I think this is a unique service and has some potentially life-saving benefits, but I have to admit - the idea that dropping this charm on the ground leaves my information potentially vulnerable.   (Important note:  "regular medical information" can also be engraved on the charm, so it's not just a PIN code.)  WellAlarm has received some good press this morning already, being featured in this morning's HARO newsletter.  I'm curious to see where this product lines goes.

This is a green dot.Bob Hawkins sent me a copy of his terrific book, The Joy Of Diabetes.  I'm a huge fan of anything that helps to raise awareness for diabetes in a way that's easy for people to understand and identify with.  Bob writes about his 45+ years with type 1 diabetes in a way that isn't intimidating.  His little cartoon avatar explores everything from alcohol to exercise to aiming for the joy in life.  I definitely recommend his book, and you can order a copy from his website.

This is a green dot.And I heard from Katie, one of my readers in NYC, that she's starting a support group which is meeting fro the first time on November 18th at the Friendman Diabetes Institute.  According to the flyer, "This group is open to members of the public who are young women living with diabetes. There is no cost for participation. The group will be self-led however there will always be a staff member from Friedman Diabetes Institute available during the meetings. We are creating a place to talk with others about living with diabetes, particularly as young adult women. If you think this group is for you, it probably is. Please get in touch and let us know that you are interested and if you can make it to the first meeting."  For more details, check out this flyer and email Katie at DiabetesNYC [at] gmail [dot] com.

This is a green dot.One other thing, for all your vloggers out there: The JDRF, Discovery Health, and Novo Nordisk are calling for video submissions for their Young Voices: Life With Diabetes program. Videos are being accepted until November 1st, so get cracking!  The videos should be "highlighting your attitudes, wishes, and needs for how the next U.S. president can help defeat this disease."  Okay, easy enough.  The website states:  "For video submissions, Novo Nordisk will donate $10 to the Juvenile Diabetes Research Foundation to help fund research leading to a cure for type 1 diabetes. For teams, group entries, or multiple videos submitted by an individual, a single donation of $10 will be made. Novo Nordisk will make a total donation of up to $25,000."  For more information, visit the Young Voices website and raise your voice!  :)

That's all for the goodie bag today, aside from piles of tissue paper that Siah is already dancing around in.  

Oh, one last thing:  I bet I'm the last person on the whole damn internet to see this video clip, but have you caught the drunken Orsen Wells commercial?  The moment at 0:51 made me laugh so hard that I watched it several times over.  "MmWaaaHaaa ... the Frensh!"

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 02, 2008

A Unified Front.

United by diabetesTmana wrote a post on TuDiabetes today that hit home and hit hard. An excerpt:

"I am concerned that these different outlooks and interests could, rather than unite us in the common cause of improved quality of life and life expectancy for people with diabetes, cause public conflicts that could rob all of our communities of the resources needed to assist diabetics, both within our online communities and outside of them."

I agree with this whole-heartedly.  While I'm an in-house editor at dLife, a member of several online communities like TuDiabetes, Diabetes Daily, a diabetes blogger here at SUM, and an active supporter of organizations like the JDRF, ADA, CWD, and DRI, these things all come second to why I'm doing this in the first place:  I am a person with diabetes, a diabetic, a type 1, pancreatically-challenged ... whatever you want to call me, I have diabetes, first and foremost.

What I care about is improving my life, and our collective lives, as we live with diabetes.  I want to see support communities do just that - SUPPORT.  The very concept of different online groups pitting against one another is ridiculous.  Aren't we all working towards the same common goal?  To live long, healthy, and well-supported lives with diabetes?  To see technological improvements?  To see a cure, maybe in our lifetimes? 

Everyone has different agendas and different goals - I understand that.  But I also understand that diabetes is not a business to me.  It's my life - our lives.  And anything that can improve that life should be supported and encouraged, despite whether or not I'm a member or if I participate in a fundraising walk. 

And while I understand the business aspect of different companies and organizations, I don't like the idea of division.  I don't like the idea that three different places are working their tails off to cure this disease, but not sharing the data.  I am not sure who crosses what communication lines, but I want to know that the JDRF, DRI, and other research hubs are sharing their theories on curing this disease.  That is happening, right?  We're all working together to cure this, right?  There are so many different diabetes organizations, but where is our unified front? 

In her post, tmana said that she didn't want different communities to assimilate in efforts to "merely to present a united front to the high-priced resources and partners," and I agree with that completely.  This disease is unique to each diabetic and their loved ones, and the various communities and organizations reflect that.  But I want the diabetes communities to mature and embrace one another instead of ostracizing and battling.  It sounds altruistic, but we're not talking about t-shirts here.  This is about a disease, a serious one, that we live with every day.  And while we rally behind all these different organizations, we need to remember - never, ever forget this - that we are really rallying behind one another as a community of diabetics, regardless of whose newsletter we receive or whose network we have a username in.

The "industry" of diabetes continues to grow, especially as more and more people are diagnosed every day.  But we can't lose sight of the most important aspect of these communities and organizations:  Support.   And I value the support I get from you guys here on the blog, outside in your blogs, in-person at dinners and events, and all over the internet and the Real World as a whole.

We are all living with diabetes.  Standing together does far more than walking alone. 

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 24, 2008

Kiss Diabetes Goodbye!

Us Barton girls stick together - it's a proven fact.  And when a Barton girl emails me about her efforts to raise funds for diabetes research, I have to do what I can to help her raise awareness.  Meet Valerie Riordan, both a fellow Bartonian and a type 1 diabetic, and her campaign to Kiss Diabetes Goodbye!

Kerri:  What is your diabetes story?

Valerie:  I, like you, was diagnosed with type 1 diabetes in August 1986.  Twenty two years ago this week.  It was one week before my 11th birthday.  That was one birthday I'll never forget!  I remember seeing the doctor the day after I was diagnosed.  He told me I couldn't have cake and ice cream at my birthday party.  I was devastated.  What's a birthday party without cake and ice cream?!  And so a life with diabetes began.

It hasn't always been an easy road.  I am very thankful that early on I found many friends and a very large support group in Clara Barton Camp.  At home I was the only one in school who had diabetes.  At camp I was one of many.  I loved being in a place where everyone understood.  I wish those camp years could have lasted forever.

However, my camp days did come to an end, and when they did I suffered a little diabetes rebellion.  I didn't want diabetes, so I was going to pretend I didn't have it.  I cut so far back on my insulin that I pretty much wasn't taking any.  The same was true for food.  That was pretty much nonexistent as well.  Of course I wasn't seeing my endo at this point either.  I got very, very skinny, but in my mind I was in control.  Even though my diabetes wasn't.

Fortunately for me, there was a new endo at the office I went to.  She really helped rescue me.  She got me and my diabetes back on the right track.  She was very encouraging and didn't lecture me.  With her rooting me on, I worked really hard to pull things together.  But there were still a lot of ups and downs.

Then in August 2000 I got married.  A year later, my husband and I were ready to start a family.  Then before I could even come up with a plan with my endo, I found out I was pregnant.  I, very quickly, whipped myself into shape with a lot of help from my endo.  When I was 4 months pregnant my endo started me on my first insulin pump.  Suddenly I was in the best control I had ever been in.  My A1C went from 8 to 4.8!  I amazed even myself.  My very healthy baby boy was born in May 2002.  Then I was blessed again with a beautiful little girl in August 2005.

Now at ages 6 and almost 3, they are seasoned veterans of diabetes.  They watch me do my blood tests everyday.  In fact I had to give my daughter one of my old machines to play with.  She kept swiping mine because she wanted to do a blood test like mommy.  They know mommy's pump is not a toy, but occasionally they get to help mommy by pushing the blue button.  My daughter loves to help me out by putting my pump in my pocket for me.  They know that when mommy's blood sugar is low I need sugar fast and they know exactly which soda to get out of the refrigerator for me.  And my son amazed me when he had to get blood taken one day.  They put the needle in and he didn't even flinch.  He said he knew it wouldn't hurt because he watches mommy get it done all the time.  

They don't know my life without diabetes.  They only know their mommy has diabetes.  For all they know I've always had it.  That's okay for now, but I hope someday that will change.

For now I just do my best to take care of myself, not only for myself, but for them.  So I may enjoy watching them grow for as long as I can.

Kerri:  What is the inspiration behind 'Kiss Diabetes Goodbye'?

Valerie:  A friend of mine, who's son has diabetes, told me about Dr. Faustman and the research she was doing. (Editor's Note:  YAY Dr. Faustman!)  She was very enthusiastic about wanting to do something to raise money for this project and she wanted me to be involved in it. She had an idea of what she wanted to do, but couldn't quite seem to make it happen.
 
Also, the mom's group that my friend and I belong to was getting involved in doing community service projects.  They were looking for fund raising ideas and charities to give to. So, I began thinking of some ideas.

While I was trying to come up with something, I came across this idea on the Arbonne yahoo group that I belong to.  It seemed like perfect timing!
 
Kerri:  What makes your fundraiser different from all the other diabetes fundraisers?

Valerie:  Having a son in elementary school, I've seen many fundraisers come through my house.  I feel this fundraiser is unique because it's different than anything I've ever seen, it's affordable and it's something I would use.

Continue reading "Kiss Diabetes Goodbye!" »

August 13, 2008

Three Coffeys, No Sugar.

 
This is one of the most remarkable stories I have heard in a while – three siblings, all with type 1 diabetes?  When Lori first emailed me several months ago, I was intrigued by her site, 3CoffeysNoSugar.com.  After hearing her family’s story, I had to share it with you guys.  Lori, take it away!

Kerri:   What's the story behind your involvement with diabetes?

Lori:  Our middle child, Emily, was diagnosed with type 1 diabetes almost 7 years ago. She was 2 1/2 years old at the time, and still in diapers. She had been peeing excessively and her diapers were like bowling balls; they would sometimes fall off her tiny waist from the weight of all the urine. That was really the only symptom she had.

I worked as a research scientist in my life "pre-kids," so I have the type of personality that researches every little symptom in children.  I had read somewhere that increased urination was a sign of juvenile diabetes, so I scheduled an appointment with her pediatrician and requested a test for diabetes. I'm sure her doctor thought I was overreacting. To be honest, I was hoping that my suspicions were wrong.  When they pricked her tiny finger for a blood test, I expected the nurse to say, "Everything is normal; she must have a urinary tract infection."  Instead, the nurse said, "Don't panic, but her number is so high that this meter won't read it."  (Too late, I was already panicking!)

The Three Coffeys

So began our journey with type 1 diabetes. That was October 19, 2001.  Fast-forward almost five years, and my youngest child, Matthew (age 5), was exhibiting extreme thirst symptoms. I had checked his BG on previous occasions when I thought he was drinking too much water, and in the past, his BG levels were fine.  But this one particular morning, he had peed his bed again, and when he woke up, he was so thirsty that he went to the bathroom and drank water using a bathtub toy as a cup.  I checked his fasting BG and it was close to 200.  Later that day, our beloved pediatric endocrinologist confirmed our worst fears: he, too, had type 1 diabetes.  That was September 7, 2006.

We were devastated by this second diagnosis and remained in shock for quite awhile. Yes, we already knew how to "manage diabetes" (I use quotation marks because there are many days I think the possibility of managing this disease is a myth!!). Many people pointed out this silver lining to us: we already knew what to do!  But since we had been dealing with D for five years, we also knew all the bad parts, like severe low BG episodes, sick days with ketones, counting every gram of carbohydrate, the long-term risks, and the day-in, day-out relentlessness of it.

Fast forward seven months, and our oldest daughter, Sarah (age 11), remarked that she had been feeling very thirsty lately and wanted to check her BG.  My husband, Brian, was out running errands with the kids, so he tossed Matthew's diabetes kit to her. She checked her BG and remarked to Brian, "It says 310."  Brian scolded Sarah, saying "Sarah! Don't tease about something like that!" but Sarah held up the meter and said "I'm serious."  Brian immediately called me on the cell phone, and my first thought was that she had sugar on her fingers and needed to wash her hands first. I remember thinking, "No way, there is no way Sarah can have diabetes, too. It just isn't possible!"

When they arrived home, Sarah washed her hands thoroughly and re-checked. Now, the meter said "Hi."  I grabbed a second meter and an alcohol swab and checked myself. 470.  We grabbed a third meter and cleaned a different finger with more force. "Hi."

At this point, Sarah began crying and saying "No, no! Please don’t let it be diabetes!"  She had watched her sister cope with this disease for 5 1/2 years, and her brother for the past 7 months. She was old enough to understand the huge burden this would be placing on her life. She and Brian held each other and sobbed. (I went upstairs and called a friend for support.  We deal with grief differently.)

And that is the story behind our involvement with diabetes.
 
Kerri:  Holy cow, that’s quite a story! Can you explain the "Three Coffeys No Sugar" title?

Lori:  After Emily's diagnosis, we learned about JDRF and began participating in the Walk to Cure Diabetes. 

Continue reading "Three Coffeys, No Sugar." »

July 31, 2008

CWD: Lancet Devices.

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

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

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

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

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

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

Kerri and the Renew

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

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

Kerri tried out the Multiclix, too.

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

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

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

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


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July 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 17, 2008

Give Me The Sample!

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

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

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

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

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

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

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

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

July 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 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 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.

June 11, 2008

Unreliable.

Meter accuracy - that's the target!We're back in the swing of things at home:  working, writing, laughing at the stupid cats, going to the gym, exploring our surroundings.  Stress levels are lower, thanks to the wedding being behind us, and our routine is a bit more predictable. 

BUT - before the wedding, everything was running amuck.  My schedule was erratic, work was insane, and I was stressed to the point where I couldn't wrap my head around anything.  For the six weeks or so before the wedding, I tweaked my basal rates and bolus ratios several times.  On our honeymoon, I had to tweak again due to a completely relaxed schedule.  And now that we're back, I need to re-tweak once more.

As a result of this readjustment to normal life, my blood sugars have been sort of scattered.  An occasional morning high of 197 mg/dl (which never, ever happens - my overnights are the only thing I have nailed down), some tricky lows at work, and a sticky high after lunch one day.  I'm in the process of working towards Dexcom insurance coverage, but in the meantime, I'm out of sensors and going on my meter results alone.

Last night, after we returned from the gym, I tested.  165 mg/dl post-workout.  No problem - I reconnected, took a correction bolus, and then jumped in the shower.  About five minutes into the shower, my head started to fog up as quickly as the mirror.  My brain was only half-focused on the lather-rinse-repeat routine and instead was starting to wander down that "should I test?" road.

"Nah."  I said to myself.  "I was 165 like ten minutes ago.  Insulin doesn't bullet in that fast."

I yelled out into the hallway.  

"Chris?  I feel kind of low.  I just wanted to let you know.  I'm getting out soon."

"Why don't you just get out now and test?  Do you want me to bring you juice?"  I could tell by his Doppler-voice that he was walking down the hallway towards me.

"No.  I'm fine.  I'll get out when I'm ready, okay?" 

Internal Motivation Speaker yawned in my ear, still not adjusted to being back from vacation.  "Kerri, why the highly bitchy response?  He's right, you know.  Just get out and test."

"I just tested."  I muttered to myself.  

Internal Motivational Speaker sighed.  "Just test.  God, you can be so freaking difficult."

"Fine."  Miserable.  What was with this headache, and why aren't my hands responding to my requests?  I fumbled awkwardly with the towel as I wrapped it around myself, my skin bristling at my own touch.  I grabbed my meter and dried my hands off.  Shunk.  102 mg/dl.

"102.  Maybe I'm sick or something.  I feel like shit."  I sat on the floor for a minute.  Chris stood above me, concerned.

The sound of the air conditioning unit was becoming louder with each second.  Abby came waddling up, urging her head underneath my hand so I would pet her.  Minutes passed, but they felt like hours.  What the heck was wrong with me?  I felt miserable.

I unzipped my meter again.   "I just feel so bad.  I'm going to double check."

Shunk.  35 mg/dl.

"Ah ha!  I knew it!"  I yelled.

"I knew it, too." 

"Okay, let's get some juice."  I drained the bottle in eight quick gulps, leaned back against the side of the bed, and waited for my blood sugar to rise.

It's a strange battle in my body at times.  I knew I was low.  I felt low and should have trusted my instincts.  But sometimes my instincts are unreliable, like when I feel low but am just hungry, or when I feel completely fine and am instead 345 mg/dl.  Maybe I should have trusted a CGM.  But CGMs are best for trending, not spot-checking.  So I should trust my meter.  But sometimes my meter gives me botched results that aren't the fault of hand lotion.  Arghhhh ... who can I trust?

All of these new products being buzzed about.  All of these bells and whistles and colored screens and fancy upgrades and ambitious developments.  I am so thankful for the advances, but all of these companies need to remember that we use this technology to keep us alive.  These bells or whistles aren't substitutes for old-fashioned accuracy.

June 06, 2008

Scampering Paws Friday Six.

The Friday Six:  June 6, 2008 editionThere has been so much work going on this week that we're all in meltdown mode on a Friday afternoon.  Columns are being edited, podcasts are being uploaded, and deadlines are being met.  But there's an air of Friday meltdown in the office, which includes outbursts of laughter, iced coffee, and fun.  Time for a post-wedding Friday Six!

1.  There is a dog here in the office today.  Usually, this dog is extremely chill and very well-mannered.  But for some reason, today Lucy the Dog is training for a marathon.  She's been racing up and down the hallways, occassionally munching on a squeaky toy.  So every few minutes, you hear the frantic scampering of doggy feet, accompanied by squeeeeeeeak squeeeak squeaky. This is what it sounds like in my brain when things get very hectic.  Strange to see it and hear it happening in real life.

2.  We spent a lot of time last night loading up the honeymoon pictures to Flickr.  There are some fun shots of Chris and I horseback riding on the beach, dining on the beach, and enjoying the evening scenery.  We're proofing our wedding album and hoping to receive our photo disk from the photographer next week, so wedding day photos are coming soon.

3.  I received an email from Austin Cooper last night, asking for a mention of his medical ID site, Evasion ID.  He created these bracelets as medical alert jewelry that PWDs would actually want to wear.  Check out his creations - they are pretty cool.  And 10% of all purchases goes towards the JDRF, so there's a little charity involved in this venture as well.

4.  Also, Tandem Diabetes Care in San Diego, CA is launching a new insulin pump soon.  They're also sporting a new, yet almost completely empty, website.  I received an email from their team yesterday, looking to gain some traction in the blogosphere.  I asked them for some information on the product but they didn't have any they were willing to share.  Hmmm ... would've been better to have some product details instead of a "coming soon" website, but hopefully they'll have something to show us in the near future.

5.  Back in the world of diabetes social networking, Lindsey Guerin of dLife's Blogabetes has started her own diaebtes network on Ning - Diabetic Echoes.   According to the site, "Echoes wants to provide an international place for every diabetic to get information, support and ideas. We hope to provide new treatments, physician's information, emotional support and a global community to you."  Will another new network survive?  Only time will tell. 

6.  And Nick over at Diabetes360 is looking for a new name for his insulin pump.  As he is Waldo's godfather (oh just typing that sounds ridiculously silly, as the dog scampers by with the squeaky toy in her mouth one more time), I have a vested interest in the moniker assigned to Nick's pump.  If you're feeling a bit silly this afternoon, offer up some suggestions for Nick. 

This weekend will be filled with thank you notes, a visit to a few local arts fairs, and maybe a trip to the beach.  It's supposed to be 90+ degrees in western CT this weekend, with enough humidity to make Siah as flat and listless as a kitty pancake.  Stay cool this weekend, and for my friends and co-workers at ADA's 68th Scientific Sessions in San Francisco, have fun!! 

May 07, 2008

Medtronic UltraLink.

As I mentioned last week, there was a random package from Minimed left on my doorstep.  And being the big geek that I am, I think I actually clasped my hands together and said "Oooh, what's this?"  Funny how an unexpected diabetes gadget can bring such instant joy.  The techno-joy in me implodes and I'm eager to rip open the box and push all the shiny new buttons.

But I've digressed again.  Imagine that?

I've been using the Medtronic UltraLink for a few days now, watching as the results ping directly to my insulin pump.  This is a good thing, because I never, ever entered my blood sugars manually before this.   I'm quick to test but not very vigilant with data management.  Having tools like the Dexcom and now this UltraLink are useful because I can go about my daily diabetes business and then load up the data every few days.  For someone like me, with a schedule that doesn't allow for much mucking around, this convenience is crucial.

UltraLink vs. Ultra2.  Go to your corners and let's have a clean fight.

The UltraLink is a bit bigger than my Ultra2 - not by much but apparently by enough to make the meter case about 25% bigger.  Thankfully, syncing my meter up to my pump was very easy.  I just needed to go into my pump settings, input the serial number on my meter, and viola! it's pinging results with a happy little beep.   The ping is almost instant and the results are logged in my pump, so when I upload my data to Carelink, it's easier to see the Big Picture, with insulin doses and corresponding blood sugars hanging out there together.

I'm all for convenience.  Because I, unfortunately, do not have the time to do all this blood sugar logging.  Making the process all-inclusive is a nice change from "Okay, grab the meter, load up the results to my blood glucose spreadsheet, then write in the insulin doses manually ... what the ... ugh, the thing turned off while I was scrolling through ... I can't remember if this bolus went with that result ... is Nip/Tuck on?  I'm sick of this crap already."

Lancing devices ... aren't they cute?  Awww ...

The lancing device that came with UltraLink is smaller, by comparison, than the older device I was using.  Funny how the meter got bigger but the lancer got smaller.   It's the same one that came with my UltraMini, so I was already accustomed to it's teeny shape.  A smaller lancet device works best for when I am sporting some fancy dress and teeny purse combo, forcing me to ditch my meter case and leave my testing goodies roaming loose in my purse. 

Overall, I'm finding the UltraLink to be a convenient, relatively painless switch over.  I'm still using my Ultra2 in addition to the UltraLink because I don't have enough brain cells these days to make any management changes.  Once the wedding is over and my brain starts to regain a recognizable shape, I will most like swap meters and go with this UltraLink version. 

So, rest o' the blogosphere, what's your take on the UltraLink?  Are you using it faithfully?  Does its size make you a little "eh" about it?   Are you tempted to cover it with stickers and give it a name?  (I'm looking for small squirrel stickers and am planning to call it "Harrison," but that's yet another digression.) 

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. 

March 28, 2008

The Friday Six: Weekend Prep.

The Friday Six:  March 28, 2008 editionShannon tells me it's snowing like 8 inches up in her neck of the woods.  My mother reports rain in Providence.  And it's chilly with a side of potential frogs raining down here in Connecticut - what the heck is up with this weather?  Here's the Friday Six for this bizarre-weathered Friday.

As I stated in my earlier post today, Children With Diabetes is now a part of the Johnson & Johnson family of companies.  See it ... look closer - it's diabetes, right there on the map.  Nice.  I'm excited to see how this will affect the diabetes community on the whole.  Big news!

In other diabetes-related news, April 14th is Raise Your Voice: Type 1 Diabetes Awareness Day!  There's a Facebook event if you haven't seen it already (and it's not hard to "attend," seeing as how this is a virtual event.)  Now that the troops are rallied, all we need is a logo ... and here's where you come in.  Bill over at EatSmart has offered one of his nutrition scales as a prize for our logo contest - that's a $75 value!   Here are the rules:

  1. Design a logo (the size cap is 200 x 300 pixels). 
  2. Include the event name:  "Raise Your Voice!" 
  3. Have fun designing it.
  4. Maybe have a snack while you're designing - apples are tasty.   
  5. Email it to me as an attachment to kerri [at] sixuntilme [dot] com with the subject line "LOGO CONTEST" no later than 3 pm on Thursday, April 3rd
  6. Grin because it's done and submitted.

That's it.  The winner will be decided on Friday morning and Bill (thank you, Bill!) will send you an EatSmart nutrition scale of your very own.

And one last thing on the scale:  After I posted my review of the EatSmart nutrition scale yesterday, Bill over at EatSmart gave me a call and told me that if you guys want to order your own scale, enter "KerriSentMe" into the coupon field during checkout on the EatSmart site and receive 10% off your order.  I thought that was right-kind of him - so if you're thinking about ordering a scale, score your 10% off, damnit!

I know many of you have seen the Gaping Void cartoons (this one is my favorite today), but did you know you can get business cards with these quippy little suckers on them?  I was unaware.  Now I am intrigued.  I like my business cards, but it would be kicking to have something so bizarre.  Food for thought.  And just as a sidenote:  I love these cartoons. 

Tomorrow is my wedding shower.  (Yes, I know I'm not supposed to know, but since I live out of state, I needed to know what day to come home.  So I know it's tomorrow.)  I know I need to be there at noon-thirty.  And I know it will be fun, because with my mother and my terrific bridesmaids at the helm, it's sure to be an awesome time.  Everything is happening very quickly now:  the bridal shower, then bachelorette party, then the last meetings with our vendors, then the rehearsal dinner, then the wedding ... I'm afraid if I blink, I'll find myself on the plane bound for our honeymoon.  I wish I could slow this time down so I could actually enjoy it!  Instead, I will blog it.  (This may be the mark of a blogging addiction.)

And six.  Ahhh, the final moment for me today before the weekend cracks wide open and swallows me.  This morning, at about 3 am, I woke to the sound of scritch scritching, coming from the bedroom floor.  I ignored it at first, thinking that it was just one of the cats lolling around.  But it came again, louder this time:  scritch scritch.  So I leaned up, looked to the floor, and saw Siah completely wrapped up in toilet paper.  She had completely unraveled the roll from the master bathroom, dragged the bulk to the middle of my bedroom, and made a nest in it.  Like an enormous hamster. 

I do not need a dog.  I have a Sausage cat who laughs at me.

March 27, 2008

Precision Carb Counting.

Diagnosed in 1986 with type 1 diabetes (Kerri, you're diabetic?  I had no idea...), my first diabetes meal plan involved that dreaded exchange system.  Two starches, a protein, a fat, a fruit ... a headache with each meal.  Since my insulin at the time was Regular and NPH, I was matching food to insulin and constantly chasing that bell curve.  Meal times were a constant hassle, with my poor mother whipping out measuring cups and teeny food scales at restaurants, referring to the Big Red Joslin Handbook for exchange values, and swearing under her breath with savvy and discretion.

As a result of this willy-nilly (ooh, fun phrase) mash-up of insulin and food, it was tough to hold my numbers steady.  We could only predict somewhat how my numbers would react to my mealplan.  It wasn't until fast-acting insulin, the precision of insulin pumping, and the frustrating miracle of carbohydrate counting that I was able to eat with more pleasure and better predict the blood sugar outcome.

However.

I am not good at "eye-balling" food portions.  Without second-guessing, I can convince myself that a cup and a half of pasta is only a cup.  What looks like fifteen green grapes captured in a plastic bag ends up actually being 26.  And please don't even ask me what a tablespoon of ketchup is, because I have no clue. 

Which is why, when the guy at Eat Smart contacted me about his nutrition scale, I was all about giving it a go.  He offered to send me a sample scale to review, at no cost and no payment to me.  So FYI - this is not a paid review. 

The Eat Smart scale

The scale arrived in the mail yesterday and it has a jazzy, streamlined look to it, which I like. Figuring out  how to turn the thing on and make sense of all the buttons was not intimidating to me (as I've mentioned before, I have serious techno-joy) but I could see it being a little overwhelming for someone not as tech-savvy.  However, the instruction manual was very straight-forward and within a few seconds, I was weighing in my mid-morning apple. 

According to the Calorie King website, my apple should have contained roughly 19.1 grams of carbohydrate.  This is an estimation based on the size of the apple and my perception of that size.  According to the nutrition scale, my apple contained 15.3 grams of carbohydrate.  At first glance, it looks like a "tomato, to-mah-toe" issue, but when I'm aiming to keep my numbers as steady and eliminate as many variables as possible, even 5 grams makes a difference. 

In addition to weighing random items with precision, the scale also offered up plenty o' nutritional info like calories, carbohydrates, fiber, fat content, sodium ... and on and on and on.  At this stage in my life, I'm mostly focused on carbohydrate content and occasionally sodium or fat values, but I can see how this data would be really helpful for other health conditions.  There's a list of 999 foods that are pre-programmed into the device, with an option to manually calculate using the food label on an item - like a dollop of cottage cheese or similar.  This feature was very helpful for me because I tend to eat a lot of fruits, fresh vegetables, and protein, so I don't have the benefit of an FDA nutrition label on everything I'm chowing.

So the data is helpful.  The scale is a little on the bulky side (see the picture for comparison against your average, garden variety office pen - grown fresh here in the dLife garden) and it's also on the pricey side ($75 bucks for this sucker!) but the return on this investment could be worth it.  I haven't tooled around with it enough to make a long-term assessment, but my initial feel is "Hey Scale, You're damn useful!"

Do you guys use scales to measure the "unpackaged" food?  Or are you more apt to wing it?  I'll admit - I wing it more often than I'd like, even though I'm eating a very healthy diet for the most part.  Hopefully a scale like this, a more focused determination to carefully account for my carb intake, and more coffee (yay!) will help me fine-tune this chaos.

Now let's see if this booklet has a value for "cheesecake" ... yum...

(Also, Hannah wrote a great post on the old exchange system from ADA - check it out!) 

UPDATE:  If you want to order your own scale, enter "KerriSentMe" into the coupon field during checkout on the EatSmart website and receive 10% off your order.  How's that for cool?

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