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Posts from the ‘Insulin’ Category

Guest Post: The One Diabetes Rule I Always Follow.

Thanks to the magic of the Internet and how words can travel from CA to RI by email faster than a sneeze, I’m happy to be hosting a guest post from friend and fellow PWD, Christopher Angell.  (You may remember him from such glucose tabs as GlucoLift and such guest posts as the one about decAY1c.)  Today, he’s writing about the diabetes rules he’s willing to bend and the one he always follows. 

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When I was first diagnosed and started my testing and insulin regimen, I did everything by the book. I disinfected test and injection sites with alcohol swabs (no longer recommended). I used a fresh lancet for every finger stick, and I always removed and properly disposed of my pen needles after each injection. I was a model patient (except on those nights when I washed down a giant bowl of popcorn and a chocolate bar with a bottle or so of pinot noir…).

Over time, however, my diligence started to show some cracks. After one too many meals out where I fished out my Humalog pen only to realize I was out of needles, I started leaving my last used needle on, and only changing it right before my next injection, so that worst case, I wouldn’t have to skip dinner or run home and force everyone else to wait while I retrieved my supplies. After using that “emergency needle” one or two times with no adverse effect, I got more and more lenient, until I was only changing a needle when it started to hurt (or required noticeably more force to do its job). Then of course I figured that if needles could be treated like that, lancets certainly could too- they were far less delicate to begin with, since they weren’t hollow.

When I started on a Dexcom CGM, it didn’t take me long to realize that those expensive sensors could have their lives prolonged without consequence as well, and I was regularly getting more than 14 days out them (I still do). Unlike reusing the relatively cheap lancets and needles, that had a real financial advantage. I also quickly learned that I could save my skin some wear and tear by using sites other than the FDA-approved abdomen. In fact, now I can’t remember the last time I wore a sensor there.

Even insulin, I discovered, was often (though not always) good well after its expiration date, or its 30-day window after opening, and subjecting it to a life outside the fridge was usually surprisingly benign.

Now that I’m on a pump, I generally change my cartridge and tubing every 6 days. I still take Lantus as well, and use one needle for the life of each pen, and I’m confident that I will never have to buy another lancet as long as I live (even if I were to live for 1000 years). So to say that I play fast and loose with the usage guidelines of my diabetes devices is to put it mildly. I don’t do it to be stubborn, and generally speaking I don’t do it to save money (though that’s a welcome result). I do it because every second not buying, storing, or changing a lancet, needle, sensor, or pump cartridge is a second that diabetes hasn’t stolen from me, a second that can be spent sleeping, talking, eating, ANYTHING but diabetes-ing. And if I’ve learned anything from living with a chronic disease, it’s that ultimately there are no small things – over time they all add up. Those seconds becomes hours and days over a lifetime with diabetes, so they’re precious to me, and I will only surrender them to diabetes if I truly believe I’m getting something better in return.

Which brings me to the one rule I DO always follow: I never leave an infusion set in longer than three days. Why? Limited real estate. I already know that prolonged injection/infusion of insulin changes my body, and I can tell the difference between a site that has been in one or two days and one that has been in three. I know that over time, the ability for certain locations to absorb insulin can be compromised, and I know I only have so many locations. I also believe that the next substantial improvement in my treatment will be some version of a dual hormone closed-loop pump (quite possibly Ed Damiano and Steven Russell’s Bionic Pancreas). This means I will need twice as much serviceable tissue to enjoy the full benefit of that treatment. So I’m doing my best to preserve what I have. Spending that time now correlate to very real potential benefits  in the future.

In the meantime, I’ve found other uses for my lancets.

Don’t Mind Me.

Don’t mind me …

… I’ll just be sitting here with 1 unit of Humalog left in my pump because I went to bed with 9 units left and tried to use my insulin to the very last drop.  I’ll let my dawn phenomenon-induced morning basal rate suck up the rest of this cartridge before swapping it out for a full one.  Insulin isn’t something I take for granted.  It’s precious stuff.

Guest Post: Timesulin, Innovation, and the Sniff Test.

People with diabetes know what people with diabetes want, and John Sjölund is no exception to this rule.  Diagnosed with type 1 diabetes just before he turned four, he has created a simple, streamlined solution to make multiple daily injections easier to manage:  Timesulin. I’ve used his product, and thought of it as “informed MDI’ing.”  Recently, he kicked off an Indiegogo campaign to raise funds to help bring Timesulin to the US market, and today, he’s sharing the how and why of that effort.

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If we haven’t yet had the opportunity to meet, you won’t know that diabetes doesn’t define me. Diabetes has, however, given me a platform to speak to amazing people, to ensure I live healthier than most of my non-D friends and it’s put me on a path to try to make life for all of us around the world with diabetes a little easier. In fact, I have made this my mission!

I have lived with type 1 for 28 years, first diagnosed a couple of days before my fourth birthday. I really have never known a different life to one that consists of 6-10 finger pricks a day, 4-6 insulin injections and constantly checking in with my body to check whether my blood glucose levels are high…or that dreaded low. That said, diabetes has never held me back from leading a life that is full, high-paced and filled with excitement! Kickboxing, triathlons, sky diving or traveling off the beaten path (horseback riding in Lesotho??) …I decide what I want to do and then make adjustments to allow me to do whatever I set my mind to, despite my faulty pancreas.

With this life, however, few things are as routine as taking my four daily insulin shots – one before each meal and a slow-acting injection at bedtime. And maybe it’s because I usually have a thousand things on the go, but over the years I have often caught myself feeling unsure of whether or not I had taken my shot. Do you know that feeling? I would step out of the shower, ready to get to bed and then have that sinking feeling, ‘Ugh…Did I take it, or not?’ or sit down for dinner and then have that niggling worry hit me.

Not having a way of knowing for sure was driving me nuts! The best method I had was to ask my then-girlfriend, Susan (now my wife and pregnant with our twin boys, due any day now!) if she had seen me take my insulin. Too often, we had to resort to the Sniff Test.

The ‘Sniff Test?’ Indeed.

Susan has a keen sense of smell and would sniff my belly, legs or arms to see if the smell of insulin was present around the injection site, which was the sign that I had already taken it. After a shower, however, the method was less reliable as the smell of body wash would mask the pungent smell of insulin. The sniff test just wasn’t a fail safe method to see if I had taken my insulin or not, something that 77% of physicians estimate happens as many as six times a month for those of us with diabetes, according to a study done by Novo Nordisk. Also, I tend to take my long-acting insulin in the backside … and Susan often exerted her right to not have to sniff that region in the name of healthy living!

Frustrated with the existing solutions that were available to me from large pharmaceutical brands, I gathered a team, which included my brother Andreas, one of the creators of Skype, to create Timesulin – a smart replacement cap for your existing insulin pen to simply show how much time had passed since the last shot. By having this basic information you can make decisions that will help you avoid an accidental missed or double dose of insulin – which can have very serious effects. Very importantly, we didn’t want Timesulin to incorporate wi-fi, bluetooth or USB plugs or any other mumbo-jumbo that I felt complicated life with diabetes (it’s worth noting that I am a tech junky, know html and CSS, can program, but when it comes to diabetes I believe in the idea of ‘Keeping it simple’). I’m proud to say that we created a product that encompassed all of this – and is today being sold in forty countries around the globe – two years after launching to consumers in February 2012!

As proud as I am on a personal level that our simple solution has helped so many people, I am super frustrated that we haven’t been successful in getting our product to the United States. Why you may ask?

  • Requirements for U.S. regulatory registration (which function well, we are supporters of keeping people safe) on medical devices are lengthy and more expensive than in Europe. It is a big undertaking for my team both in cost, time and resources to get it done, with no 100% guarantee that it will be worthwhile
  • The sheer size of the U.S., which makes distribution and logistics a challenge.
  • The costs of marketing a new brand in a market cluttered with medical advertising from big pharmaceutical brands with enormous budgets.

Most importantly, I realized that patients in the United States are not given the same choices about which devices will help them live their best possible life with diabetes. I want to change this.

We just launched a crowdfunding campaign on Indiegogo to help us raise the funds necessary to file for approval from the FDA and help us get Timesulin approved for distribution in the U.S. I am particularly excited about this as it truly lets those of us living with diabetes the ability to vote and decide for ourselves what tools we need. Is Timesulin going to solve everybody’s challenges with diabetes? Of course not, but it can play one small yet important part in allowing people to not be afraid of taking a double dose. Since I couldn’t find a solution that worked for me, I decided to start Timesulin. I have been super frustrated at not being able to empower other people to make that same decision for themselves, and I think that crowdfunding may just have the potential to help us.

This is just the start, we have lots of other ideas that we want to launch, which may not be blockbusters that cure diabetes, but can go a long way, until a cure is reached, in making life with diabetes a little simpler, less complicated and perhaps less scary.

We need your help to get there, and without the support of other people with diabetes, it will be impossible for us to keep innovating.

I know it has made things much easier for myself – and for Susan! – and importantly, we no longer have any of those awkward restaurant moments when it’s a toss up between pulling my shirt up to have her ‘Sniff Test’ my belly and taking the risk of an accidental double dose when I simply feel unsure of whether or not I had already administered my insulin dose. These days I just glance at Timesulin and know.

And now, so can you! Please help us succeed with this campaign and help everyone who’s ever needed a “Sniffer.”

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You can follow the Timesulin efforts through their Twitter account, learn more about the product on their website, and you can help support the campaign by visiting their Indiegogo page.  And if your significant other has ever sniffed your skin for insulin, show them this post; they are not alone.

Guest Post: How the MiniMed 530G Changed My Diabetes Management (Without Ever Even Seeing it in Person)

SUM is being borrowed today by Christopher Angell, fellow PWD and creator of GlucoLift, so that he can share his thoughts on the Minimed 530G … without having ever seen or used the system.  What is he on about?  Find out …

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Leading up to the launch of the Medtronic 530G (and what a long lead-up it was) I kept asking myself “What’s the big deal?” It seemed like, apart from a new sensor (which some data had already shown to be a minimal improvement over their previous sensor, and a far cry from the already-extant Dexcom G4 Platinum) the only real innovation was the introduction of the low glucose suspend (LGS) feature, which shuts off insulin delivery after a series of alarms alerting the user about low blood sugar are ignored. “How useful could that possibly be?” I wondered.

We’re constantly told that, because of the action curve of our rapid acting insulins, changes in pump basal delivery should be calculated for events 30-60 minutes in the future. So how does shutting off my basal drip help me if I’m crashing NOW?

Still, my curiosity got the better of me.

Now, I don’t use a Medtronic pump (Tandem t:slim), or a Medtronic CGM (Dexcom G4), and I don’t even get all of my basal insulin from my pump (my current split is about 57% from my pump and 43% from a single bedtime Lantus injection). So my experience is probably in no way directly comparable to what someone using the Medtronic system would experience. Nonetheless, I started experimenting with what I’ll call MLGS (manual low glucose suspend). I didn’t use it for all of my lows, but there are a couple situations where I’ve found it to be rather useful.

The first is where my bolus and my food may be correctly matched, but are out of step. For example, say I bolused for a meal that’s mostly protein, fat, and some slower carbs, like a steak with sides of spinach and broccoli. Then after the meal, I notice a slow dip on my Dexcom, but I KNOW that once the meal starts digesting, there will be plenty of food to give the insulin I have on board something to do.

Previously, I would have eaten one or two proactive glucose tablets to keep the insulin busy while the steak and veggies get over their stage fright. Now, I’ll just unhook my pump, or set a temp rate of 0 units for 15-30 minutes. And as long as I didn’t way over-bolus, that dip tends to reverse on its own, and I’ve managed to avoid unwanted, unnecessary carbs (delicious though they may be). This is especially useful if I’ve eaten a late dinner, and don’t notice the dip until after I’ve brushed my teeth. I can still get into bed, unhook, and read until I see the CGM line flatten out, then hook back up, without re-fouling my pristine pearly whites.

The other situation where I find myself implementing MLGS is with my serious, all-hands-on-deck lows. You know, the ones where every second spared from their depths means less of a hangover, and more of my day returned to my control. There are two caveats to using MLGS with this type of low. The first is that, since I’m not at my most functional when these lows hit, I’m more likely to use the “unhook the pump” method than the “very responsibly set a temp rate” method. This means that it’s very important to remember to re-attach my pump after I turn the corner on the low. The second is that since disconnecting, even for a little while, leaves me more vulnerable to a rebound high, I always treat these lows with glucose tablets, as opposed to my fridge-clearing binges of yore. I know when I’ve eaten enough glucose to right the ship, but I have to be disciplined enough to trust it and not pile another 50g of future disaster carbs on top.

When I do those two things successfully, my bad lows feel less bad, and I seem to recover from them faster. Can I measure/prove this? No. Do I care? Not really. If it feels to me like it’s working, and I believe it’s an improvement, then it kind of is, even without hard data to verify or explain it.

So even though I’ve never used the new Medtronic MiniMed 530G, or even seen one in person (as far as I know), it has nonetheless made a positive contribution to my diabetes management toolkit, which, when you think about it, is pretty impressive.

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Christopher Angell is the founder of GlucoLift glucose tabs (I have a stash of them in my cabinet, and they are so much better than your average glucose tab) and a good friend, diagnosed with type 1 diabetes at the age of 30.  He’s contributed here before, exploring the t:slim insulin pump and both travel and dental woes.  For more from Chris, you can check out the GlucoLift company blog.  To taste test GlucoLift glucose tabs for yourself, you can purchase them from their online store, or write to caring@glucolift.com for samples.  Tell ‘em Loopy sent you.

Spare a Rose: Halfway There!

The folks at the IDF reached out to let me know that, in a week’s time, the Spare a Rose, Save a Child campaign has raised $5,800 dollars.  We are more than halfway to our goal of $10,000!

There is still work to do.  The goal of $10,000 can be reached, through large and small donations, through outreach, through our community coming together.  Spread the word – one rose provides life for a month, a dozen provides life for a year.

Life for a Child









The Art of the Pre-Bolus.

"Fucking frost on my eggplants."  Batman tries to wait patiently for his bolus to kick in.“So it’s a Wednesday night … what’s the chance we might not be seated right away?”

“Are you talking to me?” Chris asked, pulling the car into a parking spot near the entrance of the restaurant.

“Yeah.  Sort of.  I’m trying to decide if I should bolus now, because I’m 200 and I don’t want to be high all night.  Or eat ice for dinner,” I responded.

The science of a pre-bolus makes sense to me.  Take your insulin before you eat so that it’s active in your system when the food hits.  Or, in smarty-pants terms:  “A bolus of rapid-acting insulin 20 min prior to a meal results in significantly better postprandial glucose control than when the meal insulin bolus is given just prior to the meal or 20 min after meal initiation,” states the conclusion of this study from 2010 examining the influence of timing pre-meal boluses on post-prandial blood sugars.

I put this theory into practical application during the second and third trimesters of my pregnancy, when insulin resistance was constantly on the climb, as were my actual insulin needs (thank you, hard-working placenta).  Around the 22 week mark, I needed to pre-bolus approximately 25 minutes before a meal.  Around the 30 week mark, I was upping that time frame to 45 minutes prior to eating.  And now, without a baby on board, I still try to bolus at least 20 minutes before I eat.

Making the decision to pre-bolus is a precarious one, because the success of that decision rests in the quiet of variables.  (What, too esoteric?  I wrote that sentence from a cloud.)  Pre-bolusing only works when nothing else gets in the way of eating.

Exhibit A:

Yesterday morning, I woke up to a shiny 218 mg/dL on my glucose meter, so I wanted to make sure I pre-bolused for breakfast, since morning highs tend to stick with me well into the early afternoon.  (Little jerkfaces.)  I took my correction bolus and my meal bolus in combination with one another for my meal (eggs, avocado, and a slice of toast do not judge me for eating toast), and set about playing with Birdzone until it was time for breakfast.  Only the best laid plans of this PWD were derailed by a phone call, a frantic search for Carrots (Birdy’s stuffed rabbit, who happened to be in the dryer, a la Knuffle Bunny), and falling down the email vortex for a spell.  End result?  I skipped the toast and ended up chugging some juice with my breakfast.

Exhibit B:

Before dinner out at a restaurant, I decided not to pre-bolus in the car, assuming it would be some time before we were seated.  But (of course), we were seated and eating within 20 minutes of arriving.  Even though my blood sugar was in range when I sat down, I had a post-meal spike that looked like a rocket ship taking off.

Timing is only part of the art of the pre-bolus.  For people dealing with gastroparesis, trying to predict the absorption of insulin and food is tricky.  For kids with diabetes, the art is more Pollock-y, because who knows what a kid will eat/won’t eat/might lick and then hide in a plant?  The blood sugar number you’re starting from makes a difference (or at least for me), too.  I’ve found that if I’m high, I need to wait until I see a downward slope on my Dexcom graph before I can start eating; otherwise, I start high and end up higher.  And the time of day matters for me, too.  A breakfast pre-bolus definitely needs more time to kick in than a dinner one.

Pre-bolusing, for all of its variables, is one of the most useful things I’ve done to help lower my A1C.  Keeping my post-prandials lower helps my overall control, and every time I see my endo, she nods in agreement when I mention pre-bolusing.  (She also warns me about lows every time, because she’s a doctor and also extremely smart and always has cool sneakers on /digression)

Do you pre-bolus? 

 

Smash.

It slipped out of my hand and smacked against the tile floor, making a thick, heavy sound that went silent and caused guilt almost immediately, like dropping your mom’s favorite Christmas tree ornament and watching it smash into a dozen pieces.

Brand new bottle of insulin, used previously for one, single pump cartridge filling.  I had just taken it out of the insulin bottle protector I use to keep it safe.  The insulin escaped from the bottle via a small crack at the bottom, created a small, bandaid-scented puddle on the blue bathroom tile.

“Shit.  SHIT,” I muttered angrily, the pump cartridge needle held uselessly in my other hand.  (I thought briefly about taking a syringe and drawing back as much of the puddle as I could, and then reminded myself that whatever I earned was going to be injected into my body, and also, gross.)

Loopy wandered in and stuck her fuzzy, gray nose towards the puddle, intrigued.

“Ew, no, Loopster.  Hang on,” and I reached over to grab a wad of toilet paper to mop up $140 dollars worth of insulin spreading uselessly onto the bathroom floor.

I thought about insurance coverage, and the pharmacy down the road that would allow me to pick up a new bottle in a pinch, and the insulin pen at the bottom of my purse, and my job, and my support system and I felt guilty and blessed and lucky and grateful that, downstairs in the fridge, two full, pristine bottles of life-sustaining Humalog waited in the butter compartment.

 

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