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Posts from the ‘Pumping Insulin’ Category

Untethered, After a Fashion.

Around 8.30 am, I took an injection of Levemir.

At about 9 am, I switched my basal profile to “OTHER” and disconnected my insulin pump.  The OTHER profile has me at 0.025U basal rate per hour (as close to zero as I can get on my pump) but still holds all my other settings.  I kept the pump in my purse and the infusion set attached to my body, with one of those pump caps (there are two that come with every box of Insets) to keep the site closed.

At 9.03 am, I put on a skirt with a loose waistband that had previously been tugged down by the weight of my insulin pump BUT NOT ON THIS DAY.

Throughout the day, my basal needs are served by the Levemir injection, but I reconnect the insulin pump to deliver my boluses (allowing me to take my meal boluses and correction doses with precision and also without piercing my skin another time because the infusion set is still in place).

Around 9 or 10 at night, my Levemir injection is pretty much toast (over the years, I’ve seen that Levemir leaves my system after 12 hours, so I usually split my dose completely on pump vacations), so I reconnect my insulin pump and spend the overnight connected, receiving the basal bump at 5 am that is delivered to combat the dawn phenomenon my body experiences.

And then, depending on what I’m doing the next day, I’ll decide to keep my pump on or off during the day.  The Levemir pen in my toothbrush holder serves as a reminder to take a morning dose, if that’s my jam.

I like having a choice.  Can’t un-choose diabetes, so having a choice as to how I deliver my insulin is a plus.

It sounds complicated, but it works for where I’m at right now, because I am aiming to make good on the whole “fit diabetes into life, not work life around diabetes.”  And as petty and superficial as it may sound, it made me bananas (read: super angry, not yellow and slippery) when I went to get dressed for the sticky, summer heat and didn’t have a good place to shove my pump.  On the waistband pulled my skirt down.  Between the cups of my bra made for weird lumps and also unnecessary warmth.

This kind of frustration is the shit that can send me into a week-long DBM (Diabetes Bad Mood) and I am trying to mitigate as much of that as possible.  So off came the pump.  On came the highly structured plan to untether in the most graceful way possible.

Keeping an eye on my CGM showed when things were working and when things need tweaking, and I felt at peace with my diabetes instead of Rage Against the Islets.  Which, while a solid band name, doesn’t do much for my emotional health.

My IOB and Me.

There’s a lot of data that PWD (people with diabetes) spin through on a daily basis – carbs counts, insulin units, blood sugar results, blah, blah, blaaaaaaah there’s so much shit sometimes.  I’ve been encouraged by my endocrinologist to download my data and review it every week or two in order to assess trends over time, but I don’t do that as often as I should.  I’m more of a monthly downloader, and I definitely download every night-before-the-endo-appointment, but a systematic review of my diabetes data is one of those things I could do more consistently.

However, the data is crucial to my health success.  I just tend to lean more heavily on the daily data than the month-long reviews.

Like my beloved IOB.  IOB stands for “insulin on board” and it’s a tool in my insulin pump that calculates how much insulin from my most recent boluses is still “active” in my system.  And I don’t know if most pumpers love their IOB data as much as I do, but I LOVE mine.  Love.  Stupid love.  It’s part of the trifecta of diabetes that I rely on every night before bed.

The checklist is short, but always, always the same: every single night before I go to bed, I check my blood sugar on my meter, comparing that number against the CGM graph.  Then I click through on my CGM graph to get feel for how the day has mapped.  And then I click through on my pump to check my beloved IOB to see how much insulin might be in play.  (Okay, honestly I check on my daughter in her bed first.  She’s usually asleep with her hair tousled into a huge mess against her pillow, with Loopy curled up against her legs.  But then I do all the diabetes garbage.)

Checking the IOB in conjunction with the CGM graph and my glucose number gives me a fighting chance against middle-of-the-night hypoglycemia.  And in the last year or so, it’s been a check that’s worked really well.  Several times (last night, for instance), I will look at my data sources and determine that a low might be teased out overnight, and I can pop a glucose tab or run a temporary basal rate on my pump for an hour or two to keep me in range.

My overnight lows are way less frequent than they ever have been before, and that means I clean juice and sweat from my sheets way less often, so there is a practical bonus aside from the whole “not going wicked low while sleeping” thing.

There’s the takeaway:  IOB monitoring helps cut back on laundry.  Use all the money you save on detergent to buy a bionic pancreas!

 

Couched.

“Can I lay here?”  I pointed to the almost-available section of the couch, where if Chris moved his legs juuuuust a little bit and Siah got her fat furry butt off the cushion, I could curl up and let my brain go quiet after a full day of writing.

“Sure thing,” and Chris adjusted his body.

“No,” was the message Siah sent me with her cat telepathic powers, but I snuggled in anyway.

And in one, seamless movement, the couch cushion leapt up and grabbed the infusion set from my arm with its teeth and ripped it off.  The couch’s fangs were gigantic and its talons just as daunting, determined to keep any diabetes device from properly resting against my skin.  I was livid – this infusion set was only a day old! – but I knew I was no match for the couch.  It was huge, and it had an agenda of rage.

I eased away from the cushion slowly, trying to keep from agitating the angry beast.  The couch snarled and tensed, poised to make a play for my Dexcom sensor if I dared to get comfortable against its fabric again.

“You okay?”  Chris asked.

“Yeah.  The couch ripped off my infusion set,” I started to say, and then I felt the slow drag of couch claws against my shin, warning me to embrace silence.  “I mean, I ripped off my infusion set.  I did it.”

The couch quieted and settled back against the floor.  And I went upstairs into the bathroom to put a new infusion set on.  And when I came downstairs, I sat on the floor, the steady breath of the wicked couch prickling the hairs on the back on my neck.

“Next time …” it panted like Dr. Claw.  “Next time.”

 

Beach-Borg.

Yesterday, my daughter and I went to the beach (with my mom and my aunts and half of the state of Rhode Island) and I wore a bathing suit.  I also wore a CGM sensor on my thigh and an insulin pump infusion set on my arm, connecting to the insulin pump clipped to my bathing suit.

There were a few glances, but nothing too awkward.  (Except the older kid who was sitting on the steps heading up to the bathrooms who, after staring at my diabetes cyborg stuff, nudged his sister in the shoulder and said, “What’s wrong with her?”  To which I replied, “Plenty,” and kept walking because honestly, I had to pee.)  It always surprises me, though, that I’ve never seen another pump or sensor on the beach.  All these people who are supposedly living with type 1 diabetes – where the hell are they?

It reminded me of the lady who was so concerned about the cell phone she thought I was about to ruin at the beach … hey, there happens to be a video discussing that very topic right here!

I’m rarely self-conscious about diabetes, and thankfully I have a small child who doesn’t leave much room or time for me to be stressed out about beach-borging.  But I am reminded regularly throughout the summer that my tan lines are a little different from that of my insulin-producing counterparts.

(Yes, I’m ready for Friends for Life, where borgs are the norm.)

 

Device Frustration.

Am I a crumb because I want to rip my devices off sometimes and throw them into a great, blue hole?  Like this one?  My skin is so irritated by the adhesives and intrusions of my insulin pump and my CGM that the desire to heave them into this abyss is intense.

the Great Blue Hole – I look at pictures of this thing all the time

I hate the bulk of them.  The amount of room that my devices take up on my body and the trauma they have a tendency to leave on my skin.  I simultaneously absolutely love the convenience of them.  The fact that I can take teeny, precise doses of insulin without using a magnifying glass on a syringe or when the alarm goes off in the middle of the night, alerting me to a 70 mg/dL that was sliding towards LOW … this is the stuff that makes wearing diabetes devices worth it for me.

The pros outweigh the cons by a long shot, but the cons are a thorn in my side these days.  Or, more accurately, a wicked itch on my skin.

I took my insulin pump off one morning because the site was so sore, and so red, and the mark it left on my body was like a little diabetes bullet wound.  I have a high threshold for irritation and itch, but this site was terrible and after pulling it out, I didn’t have anything even close to resembling the desire to put a new one back in.  I went on injections for 12 hours before realizing that being on the road wasn’t doing my blood sugars any favors (I was having trouble bringing myself back under 200 mg/dL – rage bolus, anyone?), so once my Levemir injection timed out, I reluctantly put a new pump site in.  Admittedly, blood sugar control for me these days is better on the pump.

It’s not just my pump sites that are irritating these days.  This morning, I noticed that my CGM site had become red, itchy, and irritated OUTSIDE OF THE TAPE.  What the actual fuck?  Usually, I have a skin response underneath where the sensor actually is, or where any of the tapes connect.  But this round, I have a proximity rash thanks probably to continuously compromised skin (linking to it here because it’s too gross to put on the blog).  So now I’m getting a frigging rash in the places where the sensor isn’t even touching?!  I’m in a hard place of feeling safer with access to CGM data but access to CGM data produces a fierce itch.

I need a breather.  But taking one leaves me exposed.  HEAVE this shit into the great blue hole!  That’s what I’m doing mentally, chucking all these things that make my skin hurt and itch into the watery hole and watching them sink to the bottom.

… but then diving in to rescue them.  Because I hate injections and I hate going to bed without seeing my CGM trend arrow.

An Animas Assist for Snap Users.

All disclosures out of the way first:  You guys know I have a professional relationship with Animas, as they have been a partner of mine since 2010, details outlined here.  Bias lens firmly in place?  Continue on.

Today I have a Q&A with John Wilson, the new VP of Insulin Delivery at Johnson & Johnson about Asante closing, the Animas connection, and an option for patients who have been left a little in the lurch.  

*   *   *

Kerri:  John, thanks for talking with me today.  Could you give a little background on who you are and what’s your diabetes connection?

John Wilson:  I’ve been in the healthcare industry my entire professional life, most recently working in oncology pharmaceuticals. In order to be successful, I need to have passion for what I do, and the diabetes space is easy for me to get my emotional arms around because I have a family connection.  Let’s face it, we all know people living with diabetes, and it’s very clearly an area of high unmet need.  I’m now leading the insulin delivery platform, focusing on Animas and Calibra products.  I work alongside my partners in the blood glucose monitoring platform – also known as Lifescan – and collectively, we are Johnson & Johnson Diabetes Solutions Companies.

Kerri:  Asante Snap users were thrown for a loop last week when the company announced it was closing its doors.  How is Animas planning to help take care of those customers who were left high and dry?

John Wilson:  This announcement caught everyone off guard, and I have empathy for both sides of it.  I know some of the people at Asante and that they care about the individuals in this community and are dedicated to this space, and I know pump users had to react suddenly to this news.  I was grateful that they [Asante] reached out to us to see if we could help.

Kerri:  So how is Animas helping these folks?

John Wilson:  First, we assembled a call-in line for Asante patients with specially trained Animas folks to triage their calls.  That number is 1-877-937-7867 X1562.  From a HIPPA compliance perspective, we couldn’t reach out to Asante users, so we had to wait for them to reach out to us, and we wanted to be ready to help.

The offer is pretty simple:  We are offering the choice of two pumps – the Animas Vibe with the integrated Dexcom G4 technology and the Animas One Touch Ping, and for patients under 18 we are offering the One Touch Ping.  It’s a net cost of $99 for the patient, with an upfront of $799 which, upon receipt of the Asante pump, we will credit back $700.  The Animas pumps are brand new [not refurbished] and we will honor balance of the warranty of their Asante pump.  This offer is available until July 17th.

Kerri:  How will Animas handle things like insurance for people who are transitioning?

John Wilson:  We know this need is immediate, and given the number of insurers, in order to determine whether or not they would cover it, it would take too long for the patient to be back up and running.  This is why we decided to address the immediate need with the $99 cost to the patient.

Kerri:  Customer service means so much to people who are living with diabetes, as our lives depend on receiving our supplies and medications in a timely manner.  This is big deal.  How does Animas plan to handle their existing customer base while helping the incoming PWD?

John Wilson: My team is focused on streamlining processes and improving the customer experience, and we have invested in this area.  It’s critical that we get this right.  We want to reduce the amount of time that people remain on hold, we want to call people right back and make the process as seamless as possible.  I recognize we have had misses in the past, but I’m committed to removing obstacles in order to make this process better.

I think it’s always best to operate transparently.  If I fall short of your expectations, I should acknowledge that.   My hope is that we can ultimately exceed everyone’s expectations.

*   *   *

So here’s the fine print:  There aren’t any returns, exchanges, or upgrades in this offer.  To start the process of receiving a replacement Animas Insulin Pump, they are asking that any Asante Snap pump patients to call toll free 1-877-937-7867 X1562.  Their Customer Care Representatives are available to help people out Monday – Friday, 8:00 AM – 8:00 PM EST.  Here’s a link to all the stuff.

It’s also important – and exciting! – to note that the Asante technology is not lost and gone forever.  Last week, Bigfoot Biomedical purchased all of Asante’s pump resources, with plans to pair the pump with Bigfoot Biomedical’s artificial pancreas components.  Way more details are in the diaTribe article, if you’d like to read up.  Also, Animas is just one of the pump companies who are stepping up to meet the needs of the Asante users.  Tandem has their offer outlined here and Medtronic details are here.

Updated:  Diabetes Mine has a great interview with Bigfoot Biomedical’s Jeffrey Brewer up today!

Man, this post keeps going.  I’m going to stop it now, but not without adding this awesome .gif (courtesy of The Space Cupcake):

No Disassemble.

I need to exorcise the technology demons in my house.  Because everything is breaking.

It started several months ago, the issue with my laptop, but in the last two weeks, my computer has gone entirely bananas.  I have a Macbook Air as my primary office computer and the bulk of my work is on that machine.  And it worked fine for several years, until the trackpad on the computer started to over-react to everything.  I’d tap my finger on the trackpad and every email in my inbox would open, files would delete themselves, and browser windows threw themselves against the side of the glass.  Crazy shit.

“Why are you so sensitive?!” I yelled at the computer.

“I don’t knooooooooooooow!!” It sobbed in return.

I did a lot of Google searches, and my computer wasn’t the only one feeling super fragile and sensitive.  It was not alone.  (And if your computer is going berserk, you are not alone.)  But last week, while traveling, the computer refused to click on any damn thing while simultaneously clicking on every damn thing, it wouldn’t connect to wifi, and it bit me when I opened it.  (Sharp teeth on that little sucker.)  Because I do not work in a formal office but instead house my business entirely in a computer, I had to make the rotten decision to replace my computer.

Fine.  That problem is solved, albeit in the most expensive and irritating way possible.  Then last night my FitBit decided to go rogue on me, in the middle of an intensely competitive FitBit challenge (cough – @miller7 – cough), rendering it useless.  This morning, my Dexcom receiver did that weird “BEEEEEEEEEP!” thing where static electricity or something courses through it and it restarts on its own.  En route to a doctor’s appointment at the crack of dawn this morning, the GPS in my car took me to somewhere that was not the doctor’s office but instead a supermarket (so I bought apples).

Everything with a battery or a digital footprint is breaking.  I’m afraid.  And then I realized that the way I receive my insulin is via an insulin pump, powered by a battery, chock full o’ breakable technology.  A cold panic washed over me as I worried the tech demons were contagious.

“Shhhhhhh … you’re okay.  You’re my friend,” I said to my insulin pump, as I held it in the palm of my hand like a fuzzy hamster.  “Be good.  No disassemble.  Keep working,” I murmured to it, stroking it gently with one fingertip.

Here’s hoping.

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