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Posts from the ‘Robot Life’ Category

Magic Kingdom, Magic Bathrooms.

“Is that an insulin pump?”

I was standing outside of the stall in a bathroom in Tomorrowland, waiting for my daughter to wash her hands.

“Yes, on my arm here?  Yes, it is.”  I pointed to the infusion set on my right arm, the tubing snaking back up my sleeve into my dress.

“Oh!”  The lady smiled really big, relieved.  “Do you mind if I show my son when he comes out of the stall?  He’s five – was diagnosed with type 1 diabetes when he was three.”

“Of course!”

The bathroom continued being a bathroom for a minute more, then her son came out.

“Henry, this lady is wearing an insulin pump.  Remember I told you about those?  Look, it goes right into her arm here!”

His little face was so little, just a few years older than my own son, a few years younger than my daughter.

“Hi, Henry.  I’m Kerri.  I was diagnosed with diabetes when I was seven.  This insulin pump is what I use instead of shots to take my insulin.  Want to see?”

He nodded.

“This is the little spot where the insulin goes in, and this tube connects here,” I pulled my pump out so he could see it.  “And the insulin is stored in here.”

Henry’s mom smiled.  “I was telling you about this!”  She turned to me.  “I was telling him about this.”

“If you touch this screen, it lights up.  Want to try it?”

His face broke into a grin.  I showed him how to tap the 1 … 2 … 3 buttons on my t:slim X2 to wake it up.  “If I wanted to take some insulin to have a snack, I’d press this button, tell it what to give me, and then I’d be all set!”

I turned to his mom.  “Are you guys here for the conference?”

She looked confused.  “What conference?”

Showing her the green bracelet on my arm, I explained that we had just spent the week at Friends for Life, hanging out with friends and making diabetes feel commonplace for a few days.  “So many families go.  Some parents bring their kids who have diabetes.  And in my case, I’m the one with diabetes, so I bring my kid to meet other kids of parents with diabetes.”

(This whole conversation is taking place while our kids are washing their hands and playing with the hand dryers.)

Before the next stall could flush, we’d figured out that we lived close-ish to one another, and that we had some common stomping grounds.  At my urging, Henry’s mom opened my phone and started an email to herself.

“I’ll send you an email after we leave the park with some details on the conference.  And if you have any questions about insulin pumps or connecting Henry with other kids who have diabetes, or anything at all about anything, I’d be so happy to connect,” I said.

All hands washed, we shook them, laughing about the awkwardness of meeting in a bathroom.  And then I sent my now-new favorite email intro ever, opening with, “We just met in the bathroom at Magic Kingdom (great way to start an email, right?) and I wanted to email you right away.

A few days ago, I heard from Maggie.  Our bathroom connection has come full circle.  Advocacy can happen anywhere: in a conference hall, on an airplane, in the grocery store.  Even in a bathroom at Disney World, our community is flush with connection and possibility.

Your moop or mine?

The first flight out was jumbly, with the plane riding into some kind of air pocket right after takeoff, eliciting audible screams from some of us.  (No, not from me.  Turns out that, if things get scary, I resort to frantically saying the F word under my breath whilst clutching the arm rest.)  Once the plane hit some smooth air, everyone breathed a little easier and tried to mellow out.

In the silence of folks calming down, I heard that low, moop sound that the Dexcom G5 app makes when it is ready to be calibrated, like the sonar ping from a submarine.  It’s subtle but unmistakable.

Moop.

My sensor was fine when I boarded the plane.  I pulled out my phone anyway, just to make sure my CGM wasn’t crying for attention.  Huh.  Not me.  Sliding the phone back into my purse, my peripheral vision caught the movements of the woman next to me, who had her phone in hand and I could see the little pigeon head I knew by heart.

“Type 1?”

She grinned.  “Yeah.”

“Me, too.  Since I was seven.”

“I was 13.”

“I thought it was my CGM that needed to be calibrated,” I said, gesturing towards my phone.  “But it was you this time.”


It’s the thread that runs through all of us, that instant and unfettered understanding of the thing that simmers on the back burner some days and threatens to burn the house down on others.  I know that feeling. So did the woman next to me.

Instantly, she became familiar. I didn’t know her name or where she lived or what kind of history she brought on board with her, but there was an instant connection of, “Yeah, me too. I know that thing you have. I also moop.  And beep. And check. And worry. And celebrate. And dose. And fight. And laugh. And keep perspective. And move on.”

Hips Don’t Lie.

“You’re early for your appointment!”  The receptionist looked at me hopefully.  “Less nervous this time?”

(My track record as a nervous dental patient follows me everywhere.)

“Yep.  I’m early.  And I have a babysitter this morning for my kid.  I have to follow through now!”

Over the last seven years or so, I’ve finally hit stride with my dentist visits.  Very sensitive teeth and an obsession with flossing and brushing at home made me feel invincible, skipping cleanings because they were painful and only showing up for emergency dental appointments (like this).  But I’ve been trying to practice what I preach about preventative care, so showing up every six months for cleanings and scheduling repairs immediately is my new jam.

It helps that the dentists I’ve seen over the last few years have been very receptive to requests for more novocaine during repairs or sensitivity-reducing pastes during cleanings. When the procedures aren’t painful, I’ll follow through on all of them.  Which is what brought me to the dentist yesterday:  a very old filling on my back-most molar had come loose, in need of a redo.  As soon as it popped off, I made an appointment, wrangled coverage for my little Guy, and marched into the dentist armed with good blood sugars and my copay up front.

“Can I just duck into your ladies room before going in to see Dr. Fang? [Not his real name, of course.  But holy shit, I wish it was.]”

“Sure thing.  We’ll be calling you in about 15 minutes.”

In the bathroom, I went to de-pants (?), forgetting about the fresh, new pump site on the back of my right hip.  It was exactly where my waistband hit.  Which is why I deftly ripped it off when removing my pants.  Hips don’t lie.  They also don’t like infusion sets.

NEVER FEAR!  BACK UP PEN IS HERE!

Riding a wave of arrogance because I was ready for my dentist appointment and also because I knew I had an insulin pen in my meter case, I checked my CGM graph to see if I needed a little boost before my filling.  (Dentist appointments make me feel nervous, which causes my blood sugar to rise, so I expected to see an upward arrow.)  Sure enough, I was 160 mg/dL with double arrows up.

A unit will fix this right quick.

I pulled the pen cap off and saw a pen needle already screwed in.  Hmmmm.  I knew I’d used this pen when traveling in April.  Had that needle been on there for over a month?  I turned the dial on my Humalog pen to find it spongy and sticky.

Shit.  The last time I had a pen with a sticky dial, it was the result of an old needle cap that had contributed to built up pressure in the pen cartridge.  When it happened previously, I called the pharma company hotline and they advised me to check the rubber stopper on the cartridge.  I did that this time and saw that it was bulging.  I tried to push a unit into the air but nothing came out.  The pen was clogged.  No other pen.  No backup infusion set.

Awesome.  Insulin right there for the taking but no way to access it.  And my blood sugar was climbing aggressively.

“I need to run to my car for a second; is that okay?” I asked the receptionist.

She nodded, eyeing me skeptically.  “You’re coming back in, aren’t you?  Or are you making a run for it?”

“Nope.  I will be back in,” I promised.

The center console of my car is a treasure trove of crap:  lip gloss, spare diapers and wipes, glucose tabs, mints, packets of Truvia, a GPS from 2009 that wouldn’t be able to get me out of my garden never mind to a specific location, and the odd lancet or needle tip.  I was hoping to find one of those needle tips hiding in there, all sharp and new and ready to de-bulge the insulin pen pressure.

And there it was, crammed in the back corner of the console trench, unsure of how old it was but with the paper tab still over the base, so I knew it was unused.

Back in the dentist’s bathroom, I stashed my now-disconnected pump in my purse and was able to steal a unit and a half from my insulin pen (after a test bolus that exploded out of the pen and into the air – I’m sure I heard it yell, “Weeeeeee!!”), heading the high off at the pass.

Thankful for my packrat tendencies, I was called in for my appointment and after 45 minutes of drilling and scraping and refilling and novocaine and polite “Are you okay’s” from the dentist and mangled “mmm hmmm’s” from me, my tooth was filled and my blood sugar wasn’t garbage.

The moral of this toothy tale?  Bring backups of all your diabetes crap when you leave the house.  You never know when you’ll need to forage in the center console for drug paraphernalia.

The Follow Up About Dexcom.

Today is Day 7.  I’ll be pulling this sensor off in six hours.

Day 7. No filter. No rash. No worries. #dexcom

A post shared by Kerri Sparling (@sixuntilme) on

No rash.  No filter.  Does this mean no worries?

(For reference, this post is a follow up from a week ago when I put on a Dexcom G5 sensor and transmitter without a barrier underneath the sensor.  For the last four and a half years, I’ve had an allergic/irritation response to the sensor.  Big, scaly rashes would blister up and take weeks to heal … like the one currently on my left thigh.  But rumor had it that sensors with an expiration date past 8/17/2017 were not causing this rash reaction.  

So I tried a 11/2017 expiration-dated sensor and the result?  No rash. NO RASH! The only issue I noticed was some blood around the transmitter after inserting it, but I wonder if that happens more often than I realize and the Toughpad had previously kept the blood from being visible. Whatever the case, I’m not itchy yet and I’m really, really hopeful that this rash issue is tabled forever. Next question is what to do with the box of sensors that has a pre-August 2017 expiration date …)

Some t:slim X2 Q&A.

[Disclosure:  I have a relationship with Tandem Diabetes Care that is outlined here.  Bias noted?  Good.  Read on, then.]

I am notorious for holding out on purchasing a new cell phone because I’m convinced that, the moment I hand over my money for Newest Phone it will immediately become obsolete at the announcement of NEWER PHONE.

Which is why I’m so excited about Tandem’s announcement regarding the t:slim X2 insulin pump because the pump software can be updated remotely.  Which means that when new software comes out, I can gain access to it from my house instead of having to wait and negotiate with my insurance company, etc. I wanted to share details on the t:slim X2 and create a sort of blog post clearing house for questions that I have (and that folks in the DOC have asked about), so with the help of the Tandem team and public-facing information (press releases, FAQs on their website, etc), I’ve cobbled together some Q&A hopefully A’s some of your Q’s.

Does the X2 currently work with the Dexcom G4 system?

The X2 currently has the same features as the current t:slim Pump, so it doesn’t work with the Dexcom G4 system. However, the demand will hopefully be high for the t:slim X2 insulin pump when Tandem rolls out the first major software update for G5 CGM integration, so they have an upgrade program in place for t:slim and t:slim G4 customers. (See more below for info on the upgrade program.)

When can users expect the X2 to sync up with the Dexcom G5 system?

The first feature rollout currently planned for the t:slim X2 Pump is expected to be integration with the Dexcom G5® Mobile CGM system, pending FDA approval. FDA submission for this feature is planned for late 2016, and Tandem anticipates availability in mid-2017.

Has the pump body changed at all with the X2?

For all practical purposes, no. The X2 is the same size and shape as the t:slim pump. It has a durable aluminum housing and will be compatible with all accessories designed for the t:slim Pump. (For those who have invested in ten thousand Myabetic cases for their t:slim, YAY!)

Is there a time frame in place for the PLGS ( predictive low glucose suspend) update?

As Tandem continues to build on the t:slim X2 platform after Dexcom G5 CGM integration is offered, the next feature they’re planning to launch on the X2 is a predictive low glucose suspend algorithm. This will be their first-generation artificial pancreas product. The IDE for a feasibility study has been approved by the FDA and the study is scheduled to be completed in August. Tandem expects to file another IDE for a pivotal study in early Q4 and, based on the typical review timing, anticipate that the study will take place in Q1 2017.

The goal to launch PLGS by the end of 2017 remains unchanged. Tandem anticipates a six-month review process for this first-generation pump algorithm because it will come on the heels of an FDA review of the t:slim X2 with G5 CGM integration. The only differing feature will be the algorithm. The X2 plus PLGS, with all the features and benefits of t:slim, will be competitive with other AP pump offerings as it predicts hypoglycemia, which poses the greatest risk for people with diabetes.

The second-generation AP pump algorithm will also be based on the t:slim X2 platform and will include the treat-to-target AP technology that Tandem recently licensed from TypeZero, as well as Dexcom CGM technology. To date, TypeZero’s technology has been used in more than 28 clinical studies with more than 475 people, with data referenced in a number of journal articles. They anticipate that this agreement will allow Tandem to remain on schedule for a pivotal trial in 2017, followed by commercial launch in 2018.

Users will be able to update their pump software remotely with the X2 – what does that process be like for PWD?

Here’s a little testimonial:

For pumpers already on the t:slim, what are their upgrade options? 

Online here: www.tandemdiabetes.com/upgrade

t:slim Pump customers who received their pump on or after July 1, 2016: Any customer who received a t:slim Pump on or after July 1, 2016 qualifies for a new t:slim X2 Pump at no cost. The no-cost upgrade is set to expire at the end of 2016. If folks choose to upgrade after December 31, 2016, they will still have the option for a fee of $399. Interested customers should visit www.tandemdiabetes.com/upgrade and complete the “Get Started” form or contact Tandem directly at (877) 801-6901.

t:slim Pump customers who received their pump before July 1, 2016: Any customer who received a t:slim Pump before July 1, 2016 qualifies for a new t:slim X2 Pump for either $399 or $799 depending on their date of purchase. Interested customers should visit www.tandemdiabetes.com/upgrade and complete the “Get Started” form or contact Tandem directly at (877) 801-6901.

t:slim G4 Pump customers: t:slim G4 Pump customers do not qualify for a free upgrade, but do have upgrade options available to them ranging between $399 and $799. Interested customers should visit www.tandemdiabetes.com/upgrade and complete the “Get Started” form or contact Tandem directly at (877) 801-6901.

t:flex Pump customers: t:flex Pump customers do not qualify for an upgrade to a t:slim X2 Pump, since it is prescribed specifically for its larger insulin capacity. Any change from a t:flex Pump to one with only a 300-unit insulin capacity will required a change in prescription and likely proof of medical necessity for their insurance company.

Note: These t:flex Pump customers could also opt for the 30-day return policy if they bought within the appropriate window and choose a pump with an upgrade path, if their healthcare provider feels this is a better long-term solution for them.

Once Tandem has the Dexcom integration and AP features, will it still allow you to use the Share/Follow apps on your phone?

From what I last heard, Tandem is working on a mobile app for use with all Bluetooth-enabled Tandem pumps, with the goal of providing their customers the option to see integrated pump and CGM information on their pump, their smartphone, or both. Rumor has it that Tandem is also in discussions with Dexcom to determine the best way to integrate pump information from the Tandem App with CGM information from their next-generation CGM display app.

Is there any information on the little asterisk and note in regards to the remote update of software for a fee? Will there be a fee involved to update?

Dexcom G5 CGM integration will be provided to all t:slim X2 Pump users at no charge. It seems that Tandem anticipates that some feature rollouts will be at no cost for in-warranty customers and that they might charge for others. The determination regarding cost will be made individually for each software update.

How can new pumpers/pumpers looking to switch get more information?

Here is the information page on the Tandem website.

New Pumpers, feel free to contact Tandem at (877) 801-6901, Monday-Friday 6am-5pm Pacific Time, or visit the Tandem website at:www.tandemdiabetes.com/getstarted

Pumpers looking to switch, feel free to contact Tandem at (877) 801-6901, Monday-Friday 6am-5pm Pacific Time, or visit their website and fill out the Get Started form.

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