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Posts from the ‘Diabetes Tech’ Category

Dexcom Rash: Updated.

Frigging rash.  The issue first presented itself back in August 2012, leaving me scratching my head and itching my sensor sites for the next four years.

At first, I tackled the problem by trying a pile of different barrier tapes, but the only one that brought about any semblance of relief was the Toughpad.  For about a year, I used a Flovent inhaler (sprayed on my skin before applying the CGM sensor), but I was cautioned against it by my first dermatologist, who cited that the skin would become thinner and compromised after prolonged use.  For the last few years, I’ve used the Toughpad exclusively, and it’s held the rash at bay.

Sort of.

It’s never ever perfect.  I’m still itchy as eff sometimes when I’m in the midst of using a sensor (like right now, with my sensor on my right thigh and the skin around the Toughpad is bright red and I want to scratch it off until my nails break but the low alarm that went off two nights ago saved my ass entirely so I’m leaving the sensor on as long as I can stand it).  The rash doesn’t seem to be concentrated underneath the Toughpad as much as before, but now I appear to be allergic to the Opsite Flexifix tape.  Add that to the fact that I get skin irritation even if I put the new sensor next to any place where a sensor has even BEEN for the last month.

A week or two ago, I went to the dermatologist to further investigate my Dexcom rash and to hopefully find different ways to scratch that itch, so to speak.

The new dermatologist circled me like a shark, only maybe a shark in search of medical journal material.  “You’re having an allergic response to the medical device adhesive?”

“Yes.  Since 2012.”

He paused.  “So just don’t use that medical device?”

“Not an option.”  (Totally not an option, especially these days, when I can’t feel my low blood sugar symptoms and I don’t take action on my high blood sugar symptoms unless the CGM is alarming.  This is why I wear a CGM.  And while I’m taking care of two little kids, this is why I will continue to wear my CGM.)

“Okay …” said the dermatologist, looking at my arm and thighs again, assessing the skin damage.  “A Flovent inhaler, too?  You mentioned using that in the past?”

“Yes, but after being warned it would thin out my skin, I stopped.”

“Good call.  Listen, I think we can try two things:  a topical steroid cream, or a non-steroid topical cream.  I would like try the non-steroid one first, because the same skin-thinning issue would happen otherwise.”  He handed me a prescription.

We scheduled a follow up appointment and I was sent on my scratchy way.  The cream, it turns out, comes with a dozen different creepy warnings that have made me very reluctant to try it while breastfeeding my son, but I did put a little bit on my rash and, within the hour, my rash was on fire and the urge to itch was all consuming.  I’m not touching this stuff again until after I’m done breastfeeding, and even then I’ll be very conservative, in case I’m allergic to this shit, too.

I’m not sure what people are doing these days to manage their adhesive irritations, but I’m reaching the end of my available skin real estate.  Any advice out there? It’s been a very long few years of wearing the CGM 24/7 and I’ve just about run out of sites that aren’t already scaly and raw.  I hear rumors about a “sensitive” adhesive being released by the Dexcom team, and about certain elements being removed from the current adhesive makeup, but until those products are shipped to my house and not sending my skin into circus mode, I’m at an itchy loss.

Review: Verio Flex Meter.

For years, my love for the One Touch Verio Sync meter knew no limits.  Despite a slightly MS-DOS interface that only showed me one result at a time and didn’t let me scroll back to other results unless I loaded them to the Reveal application, I loved this meter.  It was small, it was accurate (as compared to my Dexcom CGM, which I feel is my personal gold standard), and it was covered my by insurance.

I really liked how it worked with the Reveal app the most, though.  I have always struggled with maintaining a blood sugar logbook, and being able to bluetooth my results to my phone and have them collect in an at-a-glance and also an in-depth data map took the heat off my data angst.

But not everyone loved the Sync.  And recently, it was scrapped and replaced by the Verio Flex meter.

I resisted the Flex mostly because I hate change (<– curmudgeon font), but a few weeks ago, I finally switched over (after putting my two Verio Syncs into a cryptex).  Here are my initial thoughts:

PROS:

The Verio Flex turns off immediately after you take the test strip out of it.  This is a nice change from the Sync, where it would either have to time out or be pushed off using the button after each blood sugar check.  The auto-off helps conserve battery (more on why that matters in the CONS section).

There’s a small color chart on the bottom of meter screen (on the actual housing of the meter – see picture) where an arrow shows up underneath each BG result to indicate low, high, or in range.  While this isn’t as useful for me because I’m familiar with the ranges recommended for me, this could be a really useful feature for folks newly diagnosed or who aren’t as familiar with in-range and out-of-range.

It comes with a Delica lancing device, which is my favorite, if you can say such a thing about a device meant to pierce skin.

It’s durable and decently priced.  I paid $19.99 for mine at CVS and when it dropped onto the hard kitchen tile that same night, it did not smash to bits.

CONS:

The battery life doesn’t appear to be awesome.  My glucose meters in the past have taken over a year to burn through a battery, but I’ve already replaced the Flex battery after about a month.  I’m sure the bluetooth transmission cycles the battery quickly, but it was irritating to have to switch out the battery so soon.  I like my t:slim pump because it can be plugged in and charged versus needing to keep a stash of AA batteries, and I liked the Sync for the same reason.

No light!  On the Sync, there was a light at the top of the meter that was bright enough to test in the middle of the night without turning on the lamp.  This was an awesome feature, and I have no idea why it was removed from the Flex, but it’s SORELY MISSED.  Never underestimate the value of a little light that keeps you from putting blood on the strip in a mangled way, wasting the strip.

And the syncing feature takes a while.  I feel like the Sync synced faster while the Flex takes more time to flex its bluetooth muscle.  The way the data maps on the app is identical, so that’s fine, but getting that data there is something I have to remember to do, so every second matters.

Overall, the Flex is similar enough to the Sync that I won’t bust the cryptex back open yet, but hopefully the next iteration will be better on battery, upload automagically to my pump, and the light will return!

Gift Ideas for People with Diabetes.

What do you get for the person who has everything … except a working pancreas?  Here are six (until me) of my favorite d-related things:

  1. Medical alert jewelry.  Looking for medical alert jewelry that isn’t clunky or ugly? I’ve always loved this simple, classic bracelet from StickyJ Jewelry and have been wearing it daily for the last few years.  It’s comfortable and chic!
  2. Diabetes books.  This one is entirely self-serving, but if you’re looking for some diabetes reading, you can pick up a copy of my book, Balancing Diabetes, or check out any of these other titles that are diabetes-centric.  Nothing like curling up with a good, islet-inspired book.
  3. Jerry the Bear.  How about some diabetes that you can cuddle?  Check out Jerry the Bear, a stuffed animal designed to teach kids about diabetes through play.  (Read more about how my daughter bonding with Jerry here.)
  4. Donate.  You can make a difference for PWD by donating to your favorite diabetes organization or charity.  Help support Children with Diabetes and keep this amazing conference going, or give thanks through the Diabetes Hands Foundation thank you cards, or consider sparing a rose to help provide life for a child.
  5. Diabetes accessories.  Bring some festive flair to your diabetes devices with accessories from Tallygear or Myabetic.  These two shops blow the basic black meter case out of the water.
  6. Diabetes decals.  Dress up your meter, or pump, or Dexcom with some designs from PumpPeelz.  You can even design your own decal right on their website!

Happy shopping, and if you have a favorite diabetes product, service, or accessory you’d like to share, please feel free to do that in the comments section.

t:slim with a Twist.

Several months ago, I switched insulin pumps.  (Here is the post about the switch, and please read this post about the disclaimer that initiated the switch.  My full disclosure page is here.)  My first impressions of the t:slim pump were drummed up over a year ago, after trialing one for a few weeks, but my real t:slim immersion came once I switched in full.

Funny thing is the timing of that switch.  When I packaged up my Animas pump in favor of a Tandem one, I had also just found out I was pregnant.  Which means that I was adjusting to life as a pregnant PWD and also to a new insulin pump.

tl;dr – There’s stuff about the t:slim pump I wouldn’t have appreciated so soon were it not for the baby-en-route.

Because dude, if I had switched a year ago, I would have been all, “Oh, it looks so cool and the touchscreen is badass, and the fact that it’s flat all the way across the front makes it easier to tuck into my clothes,” making the wearability the most important part of my switch.  Yeah, wearability matters, but not as much as ease of use and OUTCOMES does these days.

(None of the following is medical advice; remember, I’m not a doctor and currently can’t even see my feet in full these days.)

#tslim #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Entering a bolus is stupid-easy.  And this matters, since every blood sugar counts double these days (for me and for my growing son).  It takes me a few seconds to unlock the pump and bang out a bolus, and only a few extra seconds to add crucial information like my current blood glucose and the carbs I’m consuming.  Part of my over-arching problem of diabetes management is keeping apathy from creeping in; the all day, every day tasks of type 1 diabetes wear on me in a way that prevents me from taking advantage of everything technology has to offer.  Oh, so an insulin pump can calculate my insulin on board (IOB) and the dose I need to bring down a blood sugar back into range, or what’s needed to cover X amount of carbs?  HANDY INFO!  The only thing I have to do is enter that information and it spits out a result?  ALSO HANDY.  But having to scroll forever to enter information is enough to keep me from entering that information.

It’s pathetic, how often I was taking 2u of insulin because it seemed “close enough” to cover what I needed, instead of spending the time calculating the proper dose.  Being able to input this necessary information in a matter of seconds makes me actually DO IT.  My endo is very pleased with this uptick in my management, and my A1C 100% reflects these efforts.

#tslim #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Changing my basal rates is stupid-easy.  Being pregnant means that my insulin needs are changing rapidly.  First trimester brought about insanely sticky hypoglycemic events, which equaled out to dialing down my basal rates significantly and making frequent use of the temp basal option.  (Again, it’s about the button pushing – it takes me seconds to set a temporary basal rate.  Ease of freaking use FTW.)  Second trimester showed a steady climb in my weight and insulin resistance, with a marked rise in my basal rates and my insulin:carb ratios.  And now, at the beginning of the third trimester, shit is changing all over the place, with some basal rates going down a little bit and my insulin:carb ratio almost double what it was pre-pregnancy.  There’s a lot of math going on in my baby-building body, and being able to change my rates after reviewing my data on Diasend and t:connect makes for easier management.

Holding more insulin is stupid-easy.  The t:slim holds a ton of insulin (300u) and as my pregnancy progresses, I may need that cartridge to be filled in full, instead of the half-way filled I’ve been doing for the last six months.

#tslim #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Seeing my status is stupid-easy.  One button push shows me how much insulin is on board, how long it will be active, shows how much insulin is left in the reservoir, the percentage of charge left in my battery, and the time.  Oh, and what day it is.  (This matters, as the day and time are bits of information that are being eaten regularly by intense pregnancy brain.)

Not everything is stupid-easy.  This isn’t a list of perfect moments with my insulin pump.  There are pros and cons, and the time it takes to change out the cartridge and infusion set is still cumbersome.  I also am not a fan of the luer-lock tubing bulge, as it takes on a “third nipple” appearance more often than I’d prefer.  And I’ve seen more occlusion alarms with the t:slim than I did in the past.  But I’ll these cons over the pros, especially when I review my lab work from Joslin and see how strong my numbers are.

Being more on-target through my pregnancy is not stupid-easy.  Let’s not make my successes as a pregnant PWD the product of an insulin pump, shall we?  I am working my ass off to make sure my body and my baby are healthy, with just over 11 weeks left to go before we release this particular Kraken.  But having a piece of technology that alleviates the bolus math angst, makes it impossible to forget whether or not I’ve taken my basal insulin, and being able to bang out a correction dose in a matter of moments helps take the pressure off, at least a little bit.

… even if the beeps and boops might startle my developing fetus.  (If that study has any truth to it, my poor kids are screwed.)

 

SOP for TSA and PWD.

This past week, when leaving Las Vegas and heading home to Rhode Island, I had another new experience.  The TSA pat-down agent, after making a horrified face when I told her I was wearing an insulin pump, told me she has to check the pump itself and then my skin where I was wearing it. Since it was in my bra, it was a new-to-me, highly intrusive variation on the different-in-every-city pat down procedure. When asked why she had to inspect my skin, she said it was standard.

I told her I had never experienced that before, and she said, “Well, then everyone else was not doing their job.”

First time in ten years I’ve ever had that particular experience.  So I guess everyone else wasn’t doing their job this last decade?  I have seen my fair share of airports, and most of the time, going through security is fine.  Except the pat-downs keep getting weirder and weirder.

I don’t enjoy the pat-down experience, but I do it about 90% of the time.  Why do I opt for a pat-down?  For my previous pumps, their company websites advised to avoid metal detectors, etc. (Animas, Medtronic) and my current pump suggests the same:

“Your pump should not be exposed to X-ray screening used for carry-on and checked luggage. Newer full body scanners used in airport security screening are also a form of X-ray and your pump should not be exposed to them. Notify the Transportation Security Administration (TSA) Agent that your pump cannot be exposed to X-ray screening and request alternate means of screening other than X-ray. 

Your pump has been designed to withstand common electromagnetic interference including airport metal detectors.”  — from Important Safety Information on the Tandem Diabetes Care website

Since I don’t go through the metal detector unless I’m traveling with my daughter (details here), my only option appears to be a pat-down.  TSA.gov assures me that if I opt for a pat-down at the airport, instead of going through the metal detector or the advanced imaging technology revolving door thing*, this is what I’ll experience:

“If you cannot or choose not to be screened by advanced imaging technology or a walk-through metal detector, you will undergo a pat-down procedure instead. You may also undergo a pat-down procedure if you alarm the screening equipment and/or at random. The pat-down will be conducted by a TSA officer of the same gender and you may ask that the TSA officer change their gloves before performing a pat-down. The TSA officer will ask whether you have an injury or tender area to treat such areas accordingly during a pat-down.

You may request to have a pat-down in private and be accompanied by a companion of your choice. You may bring your carry-on baggage to the private screening area and may request a chair to sit if needed. You will not be asked to remove or lift any article of clothing to reveal sensitive body areas. Please note a second TSA officer will always be present during a private pat-down screening. Learn more from these frequently asked questions.”  — from the TSA.gov website, under Pat-Down Screening

TSA has a number you can call for further explanation.  There’s even a card that I can present, making my case on paper that I’d like a minute to explain myself.  And our friends at the American Diabetes Association have provided some good, “what to expect” information on their website.

I’ve had dozens of pat-downs and these experiences are diverse but not remarkably so.  Sometimes the woman who is screening me asks me to touch the Dexcom transmitter and have my hands swabbed; other times, the transmitter is ignored entirely.  Sometimes they check the bottoms of my feet.  Sometimes they confess that they have a diabetes connection.  Sometimes they want me to hold the insulin pump in my hands during the screening while other times it’s okay to keep it where it is.  I’m always asked if I want a private screening.  I’m always asked if I can stand for five minutes.  And I’m always asked to face in the direction of my belongings.

Thankfully, most often the security experience is completely mellow and fine.

But there are some weird, unsettling moments.  Like the TSA agents who run their hand from my ankle to my groin, jamming their hand forcefully against areas of my body that I’d rather not have jammed.  Or the time I was asked to take my pants down for a (in my experiences) rare visual inspection of my sensor.  There was one time that a lady tickled me the entire time (Dave Rogers from Dexcom can attest to that awkwardness, as he watched, horrified, from the next aisle over), but that was more weird than wrong.  There was the time I was made to feel like my rights had been stripped.  And it’s not always the physical acts taking place that are varied, but the response from TSA.  Apologetic, apathetic, or stoic expressions from the TSA agent are easy to roll with; the moments where I feel judged or like I’m annoying them for opting out are not as fun.

There doesn’t appear to be a true standard operating procedure for interactions between TSA and people with diabetes, but there should be.  I should not have my genitals slammed by an agent.  I should know whether or not my sternum will be examined during a screening.  My medical situation should not keep anyone from doing their job, but I should know what to truly expect so that I can prepare, not be blindsided by the different ways that TSA executes this screening.  There are lots of resources I can point to that outline my rights, but I need to remember what they are in the moment of examination and stand up for myself.  Because no one wants to see my underpants.  And I sure as hell don’t want to show them.

 

 *  Revolving doors are terrifying.  I’ve gotten stuck in them more than once and it’s super awkward and always embarrassing.  I wish I had more of an Elf approach.  

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