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Dec 10

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Hacking Diabetes.

(Seems like that post title should end with “to bits!!” including a defiant shout and then the popping open of a can of Diet Pepsi.  Or something less specific.)

Last week I traveled to Melbourne, Victoria to present at the International Diabetes Federation World Congress.  Long, Inception-esque flight.  Excellent flight attendant.*

My presentation was anchored in the “Living Well With Diabetes” track, and I homed in on the tips, tricks, and hacks that people with diabetes are using to streamline a cumbersome disease.  But the best part, for me, was getting the folks in attendance to share their tips, and to get discussions brewing between attendees.  A lot of the discussion was built around integration of diabetes devices.  “The technology we have available to us is amazing, but if we don’t wear it and use it, it’s useless.  Doctors prescribe these tools for us, but as a community, we learn to truly integrate these things into our lives.”

  • We talked about the Dexcom-in-a-glass routine, and other patients mentioned putting loose change in the same glass to further amplify the rattle.
  • I mentioned (or at least I think I did) the CGM/earthquake application hack, as well.
  • Keeping things “stuck,” in terms of devices, generated some good discussions.  We touched upon different tapes/stickies we use (Opsite Flexifix, Tegaderm, Skin Tac), and I brought up the Toughpad solution I’ve used for my sensor rashes.
  • A few HCPs in the audience shared tips they picked up from their patients.  “One of my patients had a tough time remembering to take her nighttime insulin dose, so I suggested that she tape the pen to her toothbrush.  It’s something she uses every night before bed!”
  • A patient talked about the time she swapped her basal dose for her fast acting dose.  “I spent that whole night eating.  Never again!”  To help remind her to note the difference between her two insulin pens, she wraps brightly colored duct tape around her fast-acting insulin, so she is forced to note the difference.
  • We talked about diabetes devices and their wearability, and I shared the insulin pump/wedding dress pocket idea. The pump-in-a-trouser-sock trick was also mentioned.

Whether we’re talking about how to best (read: most comfortably and practically) use diabetes devices or highlighting the need for peer-to-peer support, the discussions are important because diabetes does not exist in a vacuum.  For me, I hit diabetes management stride when the tools – glucose meters, insulin pumps, CGMs, logbooks, medications – are in my control and fit into my actual life.

If there’s something you do to make diabetes easier and you’d like to share it, please do!

*Huge shout out to Rachel, the Qantas flight attendant who only ridiculed me a little for “losing” my phone (only to realize I tucked it into my book bag during a jet-laggy moment) and was the epitome of excellent care and service for for a nervous flyer like me (QF 94 on 11/30 from LAX – MEL, and again on QF 93 on 12/8 from MEL – LAX).  Already writing to the Qantas management team to highlight her kindness, but writing it down here on the off-chance that someone who works for Qantas has diabetes.

Related posts:

One Size. Partnering for Diabetes Change. Diabetes Reality, Reframed.

Dec 9

6 Comments

Not Prescribed.

There are things that I use, regularly, to manage my type 1 diabetes that never end up on a prescription pad, but are instrumental in making the diabetes integration in my life reasonably seamless.  (In related news, I’ve never, ever owned a small purse.)

 

[None of this is medical advice.  You shouldn't ever be taking anything from the Internet as actual medical advice, especially from me.  I can't even whistle.]

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Keeping the Dexcom Stuck. Over It. Hypoglycemic Blues.

Dec 5

11 Comments

Time is of the Essence.

For the first few days I was here in Australia, I was wondering why my morning blood sugars were such crap.

“Must be the travel, or the time zone change, or the lack of sleep, or the food-on-the-go,” I reasoned.

Nope – it must have been the fact that I changed the time on my pump to PM instead of AM, giving me the basal rate pop I need in the late evening hours, instead of the wee morning hours, therefore causing me to wake up much higher than normal.

Time, especially the timing of my basal rates, is of the essence.

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Ketchup and Mustard. Diabetic Fashionista. Despite Insulin …

Dec 4

5 Comments

Taste Test.

Since it’s December now, I hope it’s okay to revisit a video that includes a festive ol’ tree in the background.  This video is about how awesome coffee is … and why it matters that the order is RIGHT.

(See also:  Now I put my own fake sugar in the cup, instead of playing coffee roulette.)

 

 

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Redefining “Diet.” Looking Back: Law and Disorder. Check Yourself.

Dec 3

5 Comments

Talking About Complications.

I wanted to share a link to this month’s diaTribe column, because it touches upon a topic I feel strongly about: discussions about diabetes-related complications.  I was diagnosed with type 1 diabetes twenty-seven years ago, but with macular edema more recently, and am learning every day about the influence of stigma and fear on my own diabetes management.

“Complications happen, and discussions about them shouldn’t be relegated to whispered fears in the bedroom after the lights are turned out. The language around complications needs to change from one of fault and guilt to that of perseverance and renewed hope. We, as a patient community, have the right to disclose our diabetes complications without being blanketed – and suffocated – by judgment. If a complication becomes part of our personal healthcare spectrum, we need to feel empowered to face this new health issue with confidence that there is life after this diagnosis, too. We should be met, by health care professionals and fellow patients alike, with the support and encouragement we need to not lose the reins on good health habits, and to be inspired to make new ones part of our regimen.”

Thanks for popping over to diaTribe to give the column a read, and I’d love to hear your thoughts on diabetes complications and the language they are surrounded by.

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Complicated. Sort-Of Guest Post: What Do You Wish Health Care Professionals Knew? Talking Travel with Lauren’s Hope.

Dec 3

2 Comments

Guest Post: Telltale Signs That I Have Low Blood Sugar.

My low blood sugar “tells” have changed over the last twenty-seven years, ranging from numb lips to crying jags to shaky hands.  The scariest symptom of all, though, has been the complete absence of symptoms, which is part of the reason why using a CGM has been such a big leap forward for me. 

Dan Fleshler has had type 1 diabetes since 1962. He blogs (more seriously) about the lessons and mysteries of diabetes at The Insulin Chronicles.  And today, Dan has offered a tongue-in-cheek guest post about his hypo signals (including one about lettuce that made me laugh out loud).

*   *   *

“Hypoglycemic unawareness” plagues me and many other people with diabetes (PWDs). It occurs when the body’s warning signs of low blood sugar –sweat, fatigue, blurred vision, etc.– either don’t kick in or aren’t recognized. When that happens and we’re unaware that we need to eat glucose, our brains don’t get enough of it and the result can be irrational and even dangerous behavior.

I’m thinking about getting a continuous glucose monitor (CGM), which will beep when I have low blood sugar. But I’m worried that I won’t be able to get used to it and hear that sometimes CGMs don’t work. Fortunately, there is another solution offered by clinicians: every PWD should develop a set of telltale, distinctive, personal warning signs to help them recognize their lows.

In my case, I know my blood sugar is getting too low whenever:

  • I pick up two heads of lettuce from a supermarket bin, call them “Paul” and “Ringo,” and loudly berate them for the break-up of the Beatles. When that happens, I know it’s time to grab the glucose tablets!
  • I walk up to a policeman I have never seen, bare my teeth and accuse him of causing the pogroms against Jews in the Ukrainian town of Kishiniev, in 1904 (my grandmother used to tell me about them).   That’s a sure sign, a dead give-away!
  • I find myself repeatedly shouting “Meep meep,” like the Roadrunner cartoon character, when I am being chased by a policeman whom I’ve accused of causing the Kishiniev pogroms.
  • I find myself agreeing with Glenn Beck.  Danger! Danger! My brain is starving for glucose!
  • Just before a Yankees game, I stand with the scalpers outside of Yankee Stadium and shout, “Who doesn’t need tickets?! I’ve got no tickets!”  Another telltale signal: I ask people walking towards the Stadium, “Excuse me, have you seen the philosopher Ludvig Wittgenstein?”
  • I burst into tears and feel heartbroken because I can’t manage to kiss the small of my back.
  • Cradling my cat Sammy in my lap, I tell him, “You’re leaving for Swarthmore tomorrow and I know freshman year won’t always be easy. I want you to know you can call me any time. I’ll be there for you.”  You’ve probably read that some dogs can recognize when their owners have hypoglycemia.  Sammy has learned to leap out of my lap whenever I mention Swarthmore. Works every time!

Hypoglycemic unawareness can be a very serious problem.  If it haunts you, please consult your physician or certified diabetes educator and find ways to prevent it.  They should help you develop your own personal, internal barometers.  Of course, please feel free to use mine.

*   *   *

Dan, thanks for posting today.  Lettuce know if you have any other strange symptoms that crop up!  ;)

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What A Low Blood Sugar Feels Like. Guest Post: I’m Going to Pump *CLAP* You Up! What A High Blood Sugar Feels Like.

Dec 2

5 Comments

First Impressions: One Touch Verio Sync.

[Disclosures up front:  I currently have a contract with Animas and I have received the Verio Sync meter for review prior to the full US launch. I was not asked to write this review.  Opinions shared, for better or for worse, are mine.  Typos, too.]

“Mawm!  Are there cookies in there?” my daughter asked, after the package containing the Verio Sync meter was delivered.  (Not sure why, as we’ve yet to receive cookies in the mail.)

“No, it’s a new meter.  To check my blood sugar,” I replied.

“Oh.  To make sure it isn’t whoa?”

I’ve been using the Verio IQ for over a year now, and I have a good relationship with that meter.  (It still buys me flowers, and I scratch its back before bed.)  I’m adjusting to not using the Ping remote to bolus (though I miss that feature) and I don’t often use the tagging feature, but I like that it’s available, if I want to use it.  Basically, I want my meter to give me accurate results and to fit into my insurance coverage.  Those are my two big needs.  If it’s cool to look at and does fancy things, even better, but those first two needs make or break my relationship with a meter.

Testing out the Verio Sync wasn’t a big switch, but there are differences between the Sync and the IQ.  The Sync, at its core, is the same meter but it syncs up with my iPhone via the One Touch Reveal app, sucking all the results over and logging them automagically.

Comparing the Sync to the IQ is apples to apples, for me, because I was already happily using the IQ.  That said, I like these apples.  Personal pros and cons?  Got ‘em.

PROS of the VERIO SYNC:

  • It looks and feels like the meter I was using (Verio IQ).  The results are consistent with my Verio IQ, and with my Dexcom results.  It fits into the meter bag I use.  It uses the same strips as the IQ.
  • The syncing mechanism is easy, and seamless, in that the Bluetooth capability on my iPhone needs to be active, and the Sync needs to be paired with my phone.  The set-up process took a matter of seconds.
  • The interface of the application is very visual, and downright pretty.  Like with the Dexom G4 system, adding in color-coding as a reference point is terrific because it gives me a quick look at how my blood sugars are doing.  Lots of green means I’m in-range often, while blue and red signify lows and highs, respectfully.  The bar graph of in-range/out-of-range is also calculated by percentages, which gives a more finely tuned look into my numbers.
  • Logging specifics like insulin dose (kind, units), activity levels (type, duration, exertion level), and being able to fine-tune the timing of my day through the logbook set-up make for personalized diabetes management.  My doctor will love this data, and I’d do well to look at it more closely.  (But how long will it be before I burn out on inputting all that data, and return to my basic meter needs of “be accurate, be covered?”)
  • Also, every data point has the option for notes, which makes a HUGE difference for me in terms of actually making the data useful.  I can say that I was 240 mg/dL before 60 minutes of moderate exercise, but being able to add that I took a correction bolus before exercising puts a post-exercise low into context more precisely than me looking at the results a few days later, forgetting I had corrected, and thinking that the moderate exercise dropped my blood sugar more than it did, in reality.  Data is most useful in context, and open-field note options are long overdue in this kind of diabetes software.  And not just in the blood sugar result data points, but ALL data points.

  • One thing I always look at on my meter(s) are the averages, and the Sync gives averages in an overall sense, but also offers blood sugar averages by time-of-day (and looking at mine, I see that that lunchtime results could use some love, as could before bed.)

CONS of the VERIO SYNC:

  • Even though the device was paired and the Bluetooth was on, it didn’t sync automagically for the first few blood sugar checks.  I’m not sure why.  Now, a week later, it syncs fine.
  • Leaving the Bluetooth active on my phone sucks the battery life away.  Not optimal, especially while traveling.
  • Entering the logbook times of day was awkward.  Sliding the little white dots around to indicate the time took longer than it should have because my fingers are stupid.
  • The Sync has a white-text-on-black-screen feel on the meter itself.  This is the biggest con, for me, because the colorful screen of the Verio IQ is easier on the eyes on all levels.  Why go backwards?
  • Rechargeable meters seem to be the wave of the future, but needing to charge my meter makes me a little anxious.  I’m already worried I don’t have all the appropriate cables, etc. while I’m traveling, and now I need to make sure I have my meter charger, too.
  • I have absolutely no idea if I’m able to export the logbook to something I can print/send to my doctor.  Having it on my phone is great, but unless I can export the data to something shareable (even a Word doc), it’s only useful to me.  (Exporting the logbooks might be an option, but at the time of writing this, I haven’t figured it out yet.)
    EDIT:  I heard from the PR outreach person for Lifescan and they updated me re: the ability to export.  From her email:  “One of the comments we noticed had to do with exporting the log book to something you can print/send to your doctor. We wanted to let you know that by sending just what is on your screen, the system allows you to control what part of the logbook you’re sharing. You can use the 14-Day Results screen to email a table with all 14 days of results – just tap on the range bar on the 14-Day Glucose Report to get to the 14-Day Results Screen. When you share this screen as an email it is converted into a table.”  I tried this out by going to the 14 Day Results page and then pressing my finger against the screen and holding to bring up a “Help/Share” menu.  By clicking “Share,” I was given the option to “Email, Text, or Cancel.”  Clicking email exported the 14 Day Results page into an email – EASY.
  • If I don’t use the app, and I only use the meter, the Sync is inferior to the Verio IQ in look and feel.
  • Which brings me to the last con:  if the usual techno-joy burnout sets in and the meter becomes simply a meter (and not a clever way to easily create a logbook), it’s not as nice to use at the Verio IQ.  Accuracy seems to be the same as the IQ, but the MS-DOS look of the Sync screen isn’t nearly as nice as the updated, clean look of the Verio IQ.

If there was a way to mash up the visual appeal of the Verio IQ meter and have that be the one that automagically syncs with an iPhone app, this meter would hit all the marks for me.  For now, I’ll bounce between the Sync and the IQ as preference and phone battery allow.

Off to see if I can mail order cookies for Cyber Monday.

Related posts:

mySugr: Feeding the Diabetes Monster. Shine On, You Crazy Pedometer. Short Dexcom Break.
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