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Keeping the Dexcom Stuck.

It’s been almost a year since the first itchy, blistering rashes showed up underneath my Dexcom sensors, but by taking a very peculiar set of precautions, the rashes are all but gone.  Thanks to the use of the J&J Toughpad underneath my Dexcom sensors, I’m able to go a full seven (plus!) days without reacting rashly.

So yay! for no rash.  But now keeping that sucker stuck is another issue entirely.

It’s not just the sensor that I’m trying to keep stuck, but the whole Toughpad/sensor combination.  Peeling edges of any kind create a domino effect where, if not addressed immediately, the whole sensor will just flop the eff off.  (Like on those days when I put a new sensor on and then pull on a pair of pants.  If the edge of the Toughpad gets compromised in any way, with rolling edges or peeling, that sensor has a life shorter my fuse … which is unfortunately quite short.)

The life of my average Dexcom G4 sensor goes as follows:

  • Prep my skin by taking a shower.  (Or, if I haven’t just showered, I wash my skin with soap and water and let it dry before starting the application process.)
  • Warm up the Toughpad by rubbing it vigorously in my hand.  (HA!  Mis-wrote that as “rubbing it vigorously with my nad” at first.  Nad warming.  Bwaaa haaaa!)
  • Stick the Toughpad to my skin and press firmly, making sure it’s stuck.
  • Remove the adhesive backing from the Dexcom sensor and place the sensor on top of the Toughpad, so that none of the sensor adhesive is touching my skin.
  • Install the sensor.  And roll on with it, as is, for a few days.
  • Once the Toughpad starts to peel (usually around day three or four), I slap some magical Opsite Flexifix tape on the edges.
  • Once the tape is starting to peel and the edges of the Toughpad are lifting away from my skin a little bit, I use the teeny, super-sharp scissors from my sewing kit and snip away the un-stuck edges of tape and Toughpad, leaving a smaller ring of Toughpad around the sensor base.
  • Then I tape that shit down again.
  • This snip-and-tape process goes on for as long as I can manage, helping prolong the life of the sensor and to also keep my frustration at a reasonable level.  See the photo above for a Dexcom sensor/Toughpad combo that’s been whittled down.

I don’t know why it works, but it does, and it helps keep my Dexcom sensor stuck for the FDA-approved seven days … and then some.

Here’s a link to the Opsite Flexifix tape, and to the Toughpads, in case you’re interested in checking them out.

Tuesday Tidbits.

Yes, I already hate myself for using that awful title.  Sounds like it comes with a side of everything-in-the-desk-drawer-of-an-elementary-school-teacher.  I’m at the tail-end of a big writing project, so while my brain is mostly occupied by that, there are still thoughts, unrelated, that have managed to escape.  And here they are, in a bulleted list.

  • The JDRF is looking for feedback as it relates to diabetes and technology.  If you’d like to give your opinion on pumps, CGMs, and all our other assorted robot parts, click through to this survey.
  • Little girls designing superhero costumes?  Right up my alley.
  • The DX is hosting an article from me about What I Didn’t Expect while I was pregnant.  It’s strange looking back three years to when I was in baby-building mode.
  • “Blood glucose test strips are at the center of diabetes life. The FDA acknowledges there are inaccurate strips in the marketplace but has no process to remove them. People with diabetes are at risk from inaccurate strips. Let’s change that.”  YES – let’s!!!
  • Frog in a Blender.  I remember this from a really long time ago.  It’s still awesome/gross.
  • Diabetes Mine is looking for submissions for their Patient Voices Scholarship program, and also for a survey on diabetes and technology (I sense a bulleted theme).  Check out Amy’s post for details.
  • Blogger Buzz Bishop writes about his perceptions of diabetes camp, and why it’s so important.
  • I love Molly’s recap of her first Friends for Life conference.
  • Lemonade doughnuts – their very existence – is cruel and unusual punishment, since I love lemonade and have been petitioning for lemonade-flavored glucose tabs, toothpaste, and grills (not the Weber variety) for at least sixteen minutes.  Dunkin Doughnuts made one.  And even the Gothamist can’t convince me to avoid it entirely.
  • Rhody-local newscasters actually broadcasted a piece on bear safety.  Our news teams are hard hitting.
  • This post, from Happy Medium, is the most amazing piece, in my opinion, to come out of Check In day yesterday.  “If you make a difference in someone’s life by writing, by tweeting, by instagraming, then you are a hero. That is a fact. Even if the only difference you make is in your own life.”  Brilliantly said.  If you haven’t read it already, please read his post.

Onward towards deadlines!  And stuff!

Pumped for the Pizza Man.

The oven broke.

It took me a while to notice, because it was upwards of 90 degrees inside of my house (no central air … we will not be making this mistake with our next house), but once I realized the stove was kaput, it was about 6.30 pm and very much time for Birdzone’s dinner.  While I’d like to say that I walked out to our garden and picked enough fresh green beans, tomatoes, and lettuce for a healthy salad, then followed up with chicken on the grill, with a dessert of fresh blackberries and cream, I can’t.  Because I never ended up planting the garden I wanted to (too much time on the road) and we don’t have a grill (still haven’t bought one) and the frigging birds keep snaking our blackberries so, to this day, I haven’t had a single blackberry from the huge bush outside due to the aforementioned dickheaded birds. /digression

So we ordered a pizza.  Judge all you want.

Birdy and I were playing in her air-conditioned room when the door bell rang, signaling the arrival of the pizza man.

“The pizza man is here!”  Birdy opened her door and let in the dragon-breath heat from the kitchen, scurrying towards our front door with her yellow Batman Princess tutu flapping at her waist.  (She wears pieces of that costume all the time.  Even the itchy bits.)  I handed her a few dollars so that she could tip the delivery person.

I opened the door and the guy handed us our pizza and drinks.

“Here you go, miss.  It’s hot, isn’t it!”  It wasn’t a statement, but a declaration, as the heat was undeniable.

“Yeah.  Our stove broke, so there was even less of a chance of me cooking.”

He smiled as Birdy said, “Hi!” from behind my legs and darted out to hand him the money.

“Thank you … um, Batman,” he said, slightly confused but offering her a friendly smile.

“You’re welcome!”  and she took off.  I thanked him, and shut the door.  A few seconds later, the door bell rang again.  (The pizza man always rings twice?)

“Hi again.  Sorry, but I forgot to have you sign the debit card slip.”  He handed me a slip of paper, and as I signed it, he asked, “Do you have diabetes?”

“Excuse me?”

“Diabetes.  Do you have diabetes?  I noticed the sticker on your car said ‘insulin’ or something on it, and I wondered if you were diabetic.”

I laughed, surprised.  “Yes, I do have diabetes.  Type 1, diagnosed as a kid.  Do you?”

“Yeah.  Diagnosed as a kid, too.”  He reached into the pocket of his cargo shorts and pulled out a Minimed insulin pump.  “I’ve been pumping for about six years.”

I lifted the corner of my shirt and flashed him my silver Animas Ping.  “Almost ten years for me.   Small world!  And that sticker on my car is for Insulindependence.  It’s a diabetes organization focusing on sports and exercise.”

“Cool – I’ll check it out,” he said, winding his pump tubing around his fingers as he shoved the pump back into his pocket.

“Cool.”  I paused, and the words tumbled out like I was confessing.  “I don’t normally eat pizza, you know.”

The pizza man grinned.  “It’s like the most complicated bolus ever.  No matter what, I never get it totally right.”  He started to walk back towards his car, waving at Birdy.  “Have a good night!  Stay cool!”

Birdy appeared from behind the door.  “Mawm, he had a pump, too!  He has diabeedles!”

“He does!”

The diabetes world is a small, small one.  Never before had I been so pumped to see the pizza man.

(Yes.  We went all that way for a horrible pun.)

Also, today has been unofficially designated as a “day to check in” (hat tip to Chris Snider) with the DOC blogs that we’re reading.  I read a lot of diabetes blogs, but I don’t often comment because I usually want to say something meaningful, instead of “I like your post.”  (But I do like your post!)  But instead of finding that meaningful comment, I usually roll on and forget to return to comment.  NOT TODAY!  Today I’m commenting on every blog I read, because that’s the name of the game.  I love this community, and today I’ll show that through comments.  So please – if you’re here, say hello!  What’s your favorite color?

 

Guest Post: I’m Going to Pump *CLAP* You Up!

Today’s guest post is from friend, fellow PWD, and creator of the glucose tabs I stuff into my face for those lovely 3 am hypoglycemic events, Christopher Angell.  These are his first impressions of life as a cyborg as he gives pumping insulin with the t:slim a run.

*   *   *

I put off pumping for a long time. When I was first diagnosed, at age 30, I wanted to get a pump right away, but my insurance company decided that my [newly diagnosed] diabetes was in fact a pre-existing condition that they declined to cover, despite my appeals. So the economic reality of getting a pump quickly squelched my desire to have one.

Faced with the reality of using MDI (pens) to manage my diabetes, I did the best I could, and got used to it (and pretty good at it). When I finally got new, better insurance over a year later, and finally had DME coverage, the first thing I did was get a CGM (Dexcom Seven+). I knew how to give myself insulin, but I wanted more info about when/how much to to give, not to mention some chance of getting a jump on my more aggressive lows. Once I had the CGM, I lost all desire for a pump. I just didn’t see how I would benefit from it enough to justify the expense/extra supplies, and all the accounts I read online about bad sites, occlusions, ripped off sites, forgetting to reconnect etc had me nervous. Sure, on MDI I might screw up a bolus and wind up in the 200s, occasionally eve the 300s, but the only way I’d end up in the 400s is if I was drunk, very sick, or just completely forgot I had diabetes. I’d gotten my A1c under 6 and I didn’t want to change anything.

Fast forward to earlier this year. That sub-6 A1c had crept upwards at each of my last four or five tests. I was having more noticeable highs (which tend to lead, one way or another, to more lows). I was traveling and exercising more, and having trouble managing my basals across time zones. I was ready to try something new.

Another reason I’d resisted a pump is that I didn’t feel like I had any more room in my pockets, and I’ve never been one to wear things on my belt. In my pockets, I was already carrying a phone, a Dexcom, a credit card case, cash, and often keys. At minimum. There was definitely no room for a pump. But within a few months of each other, Dexcom released the Platinum G4, and Tandem launched the t:slim. Put together, they were still smaller than just my Seven+ receiver. So there went that excuse. I took the plunge.

1st day – 3/27-28/13

Minimal pain/discomfort w/ insertion
Surprised by length of needle! (comfort short manual insert)
Some burning with first bolus
Occasional burning at site throughout the day
Used to bolusing carbs + protein/meal size, so carb-based bolus feels awkward. Want to feel empowered but still take advantage of new technology
Because I wasn’t using basal first day (had taken morning Lantus after forgetting it the night before) I disconnected for sleeping, which put off that adjustment.
Tubing novel (23″). Can see potential for many mishaps, but so far nothing.
Pleased with size of pump, but means it slides down deep into pocket. (selected largely based on pocketability).
Never had to think twice about how to operate it once I left training. Did extended bolus without any difficulty.
Looking forward to experimenting with different ways of wearing it.
Definitely lots of curiosity about t:slim from people once they learn I’m using it.

Day 2 – 3/29/13

Ran with it in Diabetic Lifestyle shorts pocket. Didn’t notice it at all.
Slept with it. Also not very noticeable.
Bolusing definitely easier. Not yet taking full advantage of the precision of the pump because carbs are only part of my bolus calculation, so still tend to bolus for meals in .5 unit increments, but use full wizard for corrections with good results.

Day 3 –  3/30/13

Prefer pump bolus to pen bolus overall. Not as fast, but overall more comfortable. I was not good at using new needles (always multiple days per) and feel like this is probably better for me.
Don’t love having an extra thing in my pocket, even something this small, but do love not having to carry a kit with needles, etc. at all times.
Tubing sucks. Not having a place to put the pump when changing etc is a pain (should just remove/disconnect whenever changing/undressing etc)
Wondering if there’s some sort of cable retractor device that would work with pump tubing…
As someone switching from pens, sometimes wish default bolus screen was just number pad for typing in units, still not relating to carb-centric paradigm (maybe it’s an option?)
Insulin On Board is something that I rarely thought about in a quantifiable way before. It’s now another thing to “worry” about. But, as someone who is normally data-hungry re: diabetes, I’m less engaged with this so far. But I have yet to encounter a stubborn high while on the t:slim that would cause me to rage bolus/severely stack insulin so I don’t know if my feelings will change in that situation.

Day 4 – 3/31/13

Legoland! More worry than I would have had w/ a pen in terms of riding rides etc. (losing it)
Am all for taking pump off whenever I feel like it. I assume that with time, I’ll grow accustomed to it much like with my Dexcom sensor, my wedding ring, or pants. For now, it’s foreign and at a time cumbersome, but, especially knowing I have some Lantus working no matter what, I just ditch it when it’s bothering me.
My favorite aspect is definitely corrections.  Correcting is much better, both manually and using the wizard.
Also, love the Quick Bolus. One of my concerns had been that, as a touchscreen, I’d always have to look at it to operate it. Not so with Quick Bolus feature.

4/05/13

Being sick brings up one drawback of the pump- there are now many more variables to test. Site? Tubing? Occlusion? Device?
Went to bed at 190->, gave a correction and a 20% basal increase (40% on pump due to split). Woke up higher.
In the olden days (2 weeks ago) if a correction didn’t work, I had one option: crack open a new pen/pen cartridge, shoot again, and wait half an hour (maybe drink some water and take a stroll). If that didn’t work, then I knew it was karmic retribution for not coming to a complete stop before making a right turn on red, or [took 4 puffs before passing/pressing every floor in an elevator/.…]

Testing all these variables feels wasteful. True, I could pull some insulin out of the tubing and give myself a shot with that, but honestly I only thought of that as I was writing this. As it was, frustration had me yank the site, pop the cartridge and its 38 units of insulin (enough to keep me alive for two days, three if I lived on nuts and lettuce) and start fresh (what I call “the scorched earth method”).

Thankfully, it worked. But WHAT worked? Was it the site? The insulin? A leaky cartridge? The universe deciding that my karmic debt had been paid at the precise moment that I hooked up my new rig? I’ll never know, so I don’t know what to try first the next time, assuming I actually have the time/supplies with me to go through this whole dance every time I have a stubborn high.

It’s been about four months now. It may not be obvious from those first few days of notes, but I kind of love it. I haven’t gotten new labs yet, but anecdotally I can see that my control has improved significantly. Between having a tethered pump and my faith in my Dexcom, I can now leave my house for hours with NO BAG, just my pump, my Dexcom, and glucose tabs in my pocket/car. It’s a revelation.

Though I had long ago stopped caring about being conspicuous when I bolused with a pen, my wife informed me that I no longer look like I’m taking insulin, I just look like I’m being rude and texting at the table. I guess that’s better?

I am bothered by all the extra waste from the pump, and I already have quite the visible scar posse assembling on my stomach from infusion sites I’m not too thrilled about. Sleeping with a tethered pump is not awesome, but I’m more adjusted to it than I initially thought possible. Tubing is cumbersome and unattractive. Itchy sites are itchy.

Still, right now, the pump is my weapon of choice.

*   *   *

Thanks for sharing your first impressions as an insulin pumper, Chris.  For more from Chris, you can check out the GlucoLift company blog.  To taste test GlucoLift glucose tabs for yourself, you can purchase them on Amazon.  And for a quick video with questionable animation about how GlucoLift got started, click here.  Also, here’s a gerbil shirt, because you know you want one.

Hot.

You know how hot it is.  Hot as balls.  (Horrible image.  Hat tip to every person I knew in college who used that expression, because it’s both awful and evocative in its horribleness.)  But it’s really hot outside, and anyone living in New England knows that as fact.

Two days ago, the temperature gauge in my car read a crispy 101 degrees Fahrenheit.  When the temperature is more in the “ideal blood sugar range” than the “outside temperature range,” that’s not cool.  I like my temperatures to be borderline hypoglycemic.

Our oven broke, which isn’t normally a cause for concern for me (I do not love to cook!) but it was so hot on our back deck that Birdy and I stuck a frying pan out there to see if it would get hot enough for the “it’s so hot, you could fry an egg out here!” adage.   Unfortunately, the egg just dribbled sadly onto the pan and became very, very over easy, but by the time we checked on it, we had already made fruit salad.

My daughter has lots of lovely hair, but it’s a sad state in this kind of heat.  Poor girl has ringlets fashioned by damp sweat after being in this heat for more than a few minutes.  I feel for her, and wish I could stick an air conditioner in my face for when I hug her.

This kind of heat should make me run for the water bottles and chug fluids by the liter, but instead, it’s so damn hot that I find myself not drinking much at all.  Which is leading to a little bit of dehydration.  Which means that my blood sugars are a little tougher than normal to keep in range.  Which means yay because I love any and all added challenges.

It is weird, though, that I know I need a cranked up basal rate (maybe to like 115 – 125%) to battle back against how my body responds to the heat, but I never do it in time to avoid the highs.  I only ratchet up the basal rate once I see the Dexcom starting to show northern-bound arrows.  I thought ahead yesterday and today, but I rode in the 180 – 230 mg/dL range for much of Tuesday, since the heat fried the diabetes management part of my brain.

Heat makes you delusional.  And gross.

This lady is kind of my hero, mostly because of the way she swears with such purpose about the aforementioned heat.  (NSFW, and NSFyourears if you’re easily offended by language.)

Come on, Sunday … I saw on the weather app on my phone that the heat wave is expected to break on Sunday, bringing low 80’s and high 70’s back to New England.  I can’t wait.  But while I’m forced to wait, I’ll sit here in front of the air conditioner, with an iced coffee, and hope the keys don’t melt off my laptop keyboard.

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