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That Clip, Though.

I’ve been using the t:slim pump for the better part of a year now, and over the last few months (here’s a handy disclosure that you should read for context on my relationship with Tandem), I’ve appreciated the new set of options that the t:slim has brought into my diabetes life.

… man, that sounds a little formal.  I’m too pregnant for formality at the moment.  (My feet have officially given up on being feet and refuse any covering other than socks or flip flops, and my son is moving visibly as I type, making sitting close to my desk a challenge. Eff formality.)  The reasons for the t:slim being a badass addition to my diabetes management RIGHT THIS SECOND are that I can take a bolus in a matter of seconds without scrolling through fifty different screens, I can edit my basal or insulin:carb needs with a few beeps, and the 300 unit reservoir is going to come in handy these last few weeks of pregnancy.

One challenge I’ve historically had with the t:slim pump, however, is the clip that is shipped out with it.  For me, the clip was a little bulkier than I preferred and also not as secure as I needed.  I wanted streamlined and secure, and as my pregnant body expands and clothing options like “pockets” and “waistbands” have been shoved into the distance.  I need my pump clip to be able to hang on by a thread.

This one works great, though:

I love this clip. #tslim #diabetes #insulinpump

A photo posted by Kerri Sparling (@sixuntilme) on

A friend suggested this clip to me and gave me one of theirs, but since trying it out, I’ve keep a spare or two on hand because it seriously solves all of my pump clip troubles.  The tape is very secure and I’ve had the same pump clip stay successfully stuck for the last six months.  I have no relationship with the company who makes the clip, and this is not an affiliate link or anything like that, but if you want to try out a pump clip for your t:slim (or any other pump) that is subtle, streamlined, and strong, this Nite Ize Hip Clip is worth a shot.

Hey! An informative post! Who saw that coming? Not me. Bring on the cat gifs.

cat filing his nails

Chipped Battery Cap.

When you wear something every, single day, you notice every, single bit of it.  I’ve been wearing this pump for four years and I know the lines of it by heart.  (I remember the day that I switched from Medtronic to Animas and even those similarly-structured insulin pumps felt entirely different to me in weight, curve, and especially clip.  As I wrote in my Animas Vibe initial review, change can be awkward.)

Two weeks ago, I dropped my insulin pump on the bathroom floor.  It survived the fall, but happened to fall just so and smashed the edge of the battery cap the teeniest bit.  See?  (Ignore the hard knocks look of my pump overall.  I’m tough on this thing.)

Okay, so maybe it’s not obvious (I can barely see it myself, even when it’s pointed out to my eyeballs), but my hip knew instantly.  The jagged catch on the battery cap bit into my skin all day long and drove me bananas.  (The photo is not accurate as far as how the chip lined up with my skin.  The battery cap pictured is not screwed tightly onto the pump.  When it’s on right, the chip faces my body.)

“Do you feel this?”  I asked Chris, running his finger over the edge of the battery cap.  “That teeny chip?  It’s making me crazy.”

“You can feel that?” he asked, surprised.

“I can.  I’m like the Princess and the Pea of insulin pumps.”  (That would make for an excessively long fairy tale title.)

The point of this post?  To illustrate how fully integrated these devices become into our lives, where we notice even the most seemingly insignificant blip.  And to also note how awesome it is when your local pump rep just happens to have a replacement battery cap in the trunk of her car.

What to Work On.

I’ve gotten lazy in my diabetes management.  And I’m not proud of it.  My recent A1C result was still in my goal range but not where it was a few months ago, and I’d love to return to that level of control.  Thing is, I’ve gone soft when it comes to following through on my daily diabetes duties.

Yeah.  I’m at that point in the postpartum recovery thing:  finding ways to up my diabetes game.

I can check two things off my to do list with confidence:  I wear  my Dexcom every, single day and I also have been on top of my doctor’s appointments.  Those two things get big, fat gold stars.

Other stuff needs some grooming, though.  Here’s my wishlist:

  • Check fasting BG immediately after waking up.
  • Calibrate CGM right when it requests calibration.
  • Pre-bolus at least 15 minutes before eating.
  • Exercise 3 – 5 times a week.
  • Sleep more than 5 hours a night.
  • React faster to the high alarm from my Dexcom.
  • Rotate my device sites better.
  • Remember to eat more than coffee before 1 pm.

Hmmm.  That’s a lot.  Plan of attack for each:

  • Check fasting BG immediately after waking up.  We just moved the little Guy out of our bedroom and now he’s sleeping in his crib in his own room, so I have a little more time (3 min versus zero min) in the morning before I have to run and grab him.  I need to return to the habit of keeping my glucose meter on the bathroom counter and using it before I brush my teeth in the morning.
  • Calibrate CGM right when it requests calibration.  Ugh.  This just requires being less of a lazy tool and just checking/calibrating ASAP instead of ignoring the little red blood drop.
  • Pre-bolus at least 15 minutes before eating. This one is admittedly going to be challenging, as my schedule is a little non-scheduley these days.  My son is a busy little creature and also unpredictable, so it’s challenging to find the “right time” to do things like change out my insulin pump, eat breakfast, schedule conference calls.  But as he gets older, he does seem to be settling into something resembling a pattern, so maybe this will get easier.  I’ll try to pre-bolus.
  • Exercise 3 – 5 times a week.  This one is already going in the right direction.  As mentioned, I joined a gym and that gym has childcare, so there’s no excuse.  Except days like over the weekend, when I was away for work, or today, when the little Guy is so sniffling and booger-gross that I don’t want to bring him to the daycare and expose any other kids/adults to his germs.  We did go for a walk around the neighborhood today, clocking in at least a little bit of exercise, so that helps.  The weather warming up will help here, too.  This bullet point is one I’m putting like half a gold star on.
  • Sleep more than 6 hours a night.  OH HA HA HA HA.  The baby thinks 5.30 am is when human beings should wake up.  The early morning hours are gorgeous and I love the quiet of being awake that early, but around 10 pm my body starts to give up on doing body things, although I rarely make it to bed before 11.30 pm.  I need to work on this sleep thing.
  • React faster to the high alarm from my Dexcom.  Again, this one is something I just have to DO.  No excuses and no reason not to.  My high alarm used to be 140 mg/dL (pre-pregnancy and during pregnancy), but I’ve moved it to 180 mg/dL in the last few months.  I should be responding to 180s.  I will work on this.
  • Rotate my device sites better.  Yep, this is also a need.  My thighs have become a permanent home for my Dexcom sensors, but I am okay with the back of my hip or maybe my arm.  I’ll try to get creative.  As far as pump sites, I’ve been working on rotating those better, too.  Maybe it’s time to try a lower arm site?  (Has anyone ever done that and does it hurt??)
  • Remember to eat more than coffee before 1 pm.  Yeah, this is another whoops.  My mornings are generally a bit crazy, and sometimes I’d rather keep my CGM graph steady instead of interrupting it with breakfast.  But this is backfiring because I then get so hungry around lunch time that I eat the fridge, causing a nasty post-lunch bounce.  Moderation here.  Eat regularly throughout the day and I’ll be less likely to unhinge my jaws and devour the contents of the cupboard.

I hope writing this crap down will help up my accountability and will inspire me to keep moving forward.  If I can make one or two of these become habit in the next few weeks, I’ll mark that as a success.  Because backwards is all gross and disgusting feeling and also it looks like there’s a c-section back there and I am NOT going back to that.

“Do You Like It?”

“Excuse me … your, um, arm?  What’s that on your arm?”

Ninety-five percent of the time, I don’t care if people ask about my insulin pump or CGM.  More power to them for being bold enough to embrace the awkwardness and actually ask, instead of assuming.  (And even in the 5% moments of “argh – stop looking, don’t ask,” it usually ends up being a moment of discussion and disclosure I’m grateful for.  I should be more open to discussing diabetes in a public setting.  Hang on a second … let me start a blog real quick.)

“On my arm?  That’s my insulin pump.  I have diabetes.”

I was in line at Starbucks, grabbing an iced coffee (under the gestational lock and key of decaf for just a few more weeks), escaping the blazing summer temperatures for a few minutes before heading back to work.  I was wearing a skirt and a tank top, with my infusion set connected to the back of my right arm.  My body – thanks to third trimester expansion, has run out of subtle places to stash my insulin pump, so it was casually clipped to the strap of my tank top.

Kind of noticeable, but in a “who cares” sort of way.  It’s hot outside.  And I’m wicked pregnant.  And I have no waist anymore.  You can see my insulin pump?  Good for you.  You can probably see my belly button, too.

“No kidding.  Diabetes?  Is it because of the pregnancy?”

“No, I’ve had diabetes way longer than this pregnancy.  I was diagnosed when I was seven.”

The guy paused for a second, his eyes lingering on the infusion set on my arm.  “So you do that thing instead of shots?”

“Yep.”

“Do you like it?”

That question always throws me a little.  Do I like it?  The pump?  I do like the pump.  I like not taking injections.  I like not whipping out syringes at the dinner table and exposing my skin.  I like taking wee ickle bits of insulin to correct minor highs.  I like running temp basals to beat back hypos.  I like people wondering what it might be instead of assuming it’s a medical device.

“I do like it.  It works for me.”  I paused, already envious of the coffee in his hand.  “I like coffee more, though.”

He laughed and finished paying for his coffee.  “Can’t blame you for that.  Good luck with the baby, and try to stay cool in this weather,” he said.

I don’t like diabetes.  That’s for damn sure.  That shit is exhausting and I’m burnt out on the demands it places on my life.  But the pump?  Yes, I do like it.  It’s  a streamlined delivery mechanism for a hormone I wish my body would just cave and start making again.  It handles diabetes so I can go back to trying to put my socks on without tipping over.

Livongo Health: First Impressions of Their Meter.

Disclosure:  Manny Hernandez, SVP of Member Experience at Livongo Health, reached out to me a few weeks ago about test driving the Livongo meter.  Manny is my good friend, and diabetes is not my friend, so anything that helps a friend and also helps me take a bite out of diabetes is a welcomed opportunity.  For the purposes of this post, please know that the Livongo meter starter kit was sent to me at not cost, as were the test strips.  I offered to write about my experiences.  I’m not being paid for any of this.  All perspectives are mine.

For the last few weeks, I’ve been trying out the Livongo Health glucose meter.  These are my first impressions.  For another take, check out this post from the College Diabetes Network.  Time to purge thoughts:

The glucose meter is solid, and familiar enough to not be confusing.  The meter itself is big, but nice.  It’s much bigger than the Verio Sync that I’ve been using for the last two years, and I have a fear of dropping it on the floor and having it smash into a thousand pieces (as is my life trend).  The meter also did not fit into the bag I have been using for my One Touch meter, so I had to find a bigger bag.  The test strips are also much bigger (almost comically so).  But size, for me, doesn’t matter too much since my meter exists on my kitchen counter or in my purse, never in my pocket.  The color screen is very cool.  The touch screen is even cooler, and was appropriately responsive to commands from my digits.  Nicely done.

On the whole, checking my glucose was easy, especially since I’ve used lots of different meters in my years with diabetes.  The meter lets you know when the strip is ready for blood, and while you’re waiting for the countdown to the result, the meter gives you a little health fact.  “Did you know that laughing is a great way to reduce stress (make you feel better)?”  I would have loved to have been a fly on the wall for the meetings where they came up with dozens of these gems.  I enjoyed every, single one of them, even the repeats.  They gave a dose of personality and humanity to a task that is oftentimes less-than-enjoyable.

Syncing my results to the cloud wasn’t always seamless.  More often than not, my meter would claim that the connection to cellular signal {EDIT – I originally thought this was a wifi signal, but Manny let me know it’s a cellular connection.}  was too weak, and promised to send the result after my next check.  This didn’t bother me too much, but I with there was a manual way to send my results, instead of having to wait until the next check.  Hopefully that comes with the next iteration.

On the meter, the Snapshot Summary is very useful for me.  That’s why I like the Verio so much, because it uploads to my phone, giving me at-a-glance access to what my numbers have been like for the last two weeks.  The Livongo meter hits that same sweet spot.  The Logbook screen is basic and if this was my primary meter, it would be a good screen to track.  Same for the Patterns & Stats screen.  This screen was particularly helpful because it tracked my averages for specific times of day, and then gave me a percentage in-goal range on the same screen, for 14 days, 30 days, and 90 days worth of data.  Again, it’s hard to get a full feel for how functional these screens would be in my life because I’ve only been using the meter for about two weeks.  But a meter that logbooks automatically (automagically?) is an asset for someone like me who loathes to logbook.

The Activity option on the meter confused me, to be honest.  I wear a FitBit and I enjoy those competitions, but it’s easy to wear the FitBit on my wrist while I’m moving around.  Trotting around with my glucose meter on my hip is not going to happen.  Ever.  If this setting expanded to include activity trackers outside of the Livongo brand, that would be awesome.  Otherwise, this setting becomes akin to the one on the Apple watch (for me, anyway):  I already have a fitness tracker.  I don’t want to use four of them.  Communicate with the one I already use, or maybe allow for manual input?

The online portal is comprehensive.  I like logging into the online portal and seeing the weather for my location.  It was a touch creepy at first (I am predictably creeped out by how much the Internet knows about my location), but then it became a nice thing.  Like, “Hey.  Good morning, Kerri.  It’s 54 degrees out in your sunny corner of Rhode Island.  Put on a coat before walking to the bus stop, kitten.”  Only it didn’t call me kitten.  Though I’m sure that can be programmed in.

Two notes:  In updating my personal health profile on the Livongo portal, I entered my diagnosis date (9/11/1986) and realized that the year option only went back to 1979.  Is that because it was taking my birthday into account?  If so, clever.  Less-than-clever is the field about my last A1C.  I was able to note when my last A1C was taken, and also what the value was.  But I did not have the option NOT to enter a value.  I didn’t like this.  When it comes to health information stored on an external website, I prefer the option to share or not share.  Forcing the A1C value felt … forced.

The online portal allows me to add folks to access my data, in as much real-time as possible.  I can add people (Chris, my mom, my best friend) to be alerted to my blood sugars when they are out of range.  If I had a child with diabetes, this would be a terrific option because it would help me stay on track with what’s going on when my kid is out of my arm’s reach.  But as an adult with diabetes, I don’t need to alert my family and friends if I check and am low or high.  I realize this flies in the face of my decision to share CGM data, but there’s a difference for me:  my CGM data will stream to the cloud and alert my family in the moments when I might not be awake or aware enough to check my blood sugar.  A low in the middle of the night is not always confirmed with a glucose check.  Most of the time, I wake up knowing I’m in trouble, and I treat without checking first.  The important thing is bringing up the low; I don’t need to know the exact number.

The portal also allows a health team to be created (or at least documented), letting me add my doctor to receive updates from my meter in a comprehensive way.  Again, this isn’t something I have any plans to take advantage of, but for people who need and/or want to be in more constant contact with their medical team, this is a terrific option.  (I don’t think my doctor wants to hear from me all the time, but when I was pregnant, I know she would have loved receiving my logs every two weeks, instead of me faxing them to her office.)  Through the portal, you can also access a Livongo health coach (from their team of CDEs) who will walk you through different issues at a pace set by you.  I haven’t tried this feature out yet, but if you have and can offer some feedback, I’d love to hear it.

The meter results are what matter most to me, though.  Size, color, bells, whistles, etc don’t matter when it comes to accuracy.  I have an inherent mistrust of all data (I think it stems from the lack of trust I have for my stupid pancreas), so I check and double check new devices until I feel comfortable with them.  To that end, I’ve used my Verio meter every time I’ve used my Livongo meter, and have checked both of those results against my CGM data.  (Excessive?  Yep.  But the meter came as part of a trial experience, so it wasn’t an out of pocket cost.)  Overall, the Livongo meter ran lower than the Verio meter.  Not enough to cause an uproar, but enough that I noticed every time.  My Verio meter was closer to my Dexcom on the whole, but I also use the Verio to calibrate my Dexcom, so there’s a data bias in play.  But everything was in line, well enough, to make me feel comfortable making insulin decisions off the Livongo results.

Did I trust the results?  Yes.  Well enough, at least, to be honest.  It’s hard for me not to defer to the tech that shows me as higher because when shown lower results, my brain immediately thinks, “Yes, but what if I’m actually the higher number?  That should be corrected.  I don’t want to be lulled into a false sense of security.”  I plan to use the Livongo meter to calibrate my next Dexcom sensor, to see if that shows a noticeable trend difference.  I’ve talked about new tech here on SUM often, and the running theme seems to be that I balk at change.  “New” and “different” are always initially met with a “get off my lawn” response, because I don’t like adjusting to anything new.  (Case-in-point:  The clip on the Animas pump made me crazy at first, because the top of it was just ever-so-slightly different from the Minimed one.  It took me at least two weeks to adjust to how that felt.  But then I got used to it.  Same with the new G5 transmitter, which is slightly thicker than the G4 transmitter, and it currently feeling like a doorknob attached to my thigh.  I’m sure I’ll adjust to that newness, too, but it takes me some time.  Also, you’re welcome to stay on my lawn.  I don’t mind.  It will just take a few days for me to get used to you being there.)

Looking at the cost.  There is an early access program being offered by the Livongo team right now (but rapidly drawing to a close, so if you want to sign up, I’d recommend doing that today.  Manny advised that the offer is “winding down as we speak.”).  For more details, you can click on this link or on the image below.  I’m not sure about insurance coverage for this meter and it’s associated services, but I do know that the early access program offers a deal with subscription.  From the website:  “The In Touch blood glucose monitoring system and all supplies, including unlimited strips and lancets — even shipping costs — are covered as part of your subscription.  Your participation as an early access member costs only $25 per month (guaranteed for 2 years).”  It’s the “unlimited” promise, as it pertains to the test strips, that peaks my interest for sure.  Strips are the priciest part of testing my blood sugar, so “unlimited” is a nice and welcomed bonus.

I’ll check back in a few weeks with second impressions of the Livongo meter.  If there’s anything specific you’d like to know more about, please ask!  Thanks to Manny, and the team at Livongo, for letting me give this meter a go.

 

 

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