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Posts tagged ‘CGM’

Second Impressions: Dexcom G5 Mobile.

Disclosure Up Front (where it should be)I have a relationship with Dexcom that includes receiving my continuous glucose supplies at no cost.  More details are outlined here on my disclosures page, but please know that the bias I’m bringing to this is pretty significant, not simply because of the working relationship with Dexcom but also the fact that this CGM has been part of my diabetes care plan since 2006, so I’m in deep for a dozen different reasons.  If you have any questions, feel free to reach out.

It’s been about a month since suiting up with the Dexcom G5 (upgrading from the previous G4 iteration) and so far, the transition has been way less jarring than I had anticipated.  Here are some second impressions:

The Parts I Like:

I was initially concerned about phone battery life, but I haven’t seen any significant change since switching to G5.  (Must be noted:  I upgraded my iPhone two weeks before starting on the G5, so any battery improvement was a big deal after switching from the iPhone 5s, which would eek down to 80% an hour after unplugging.  Also, I didn’t realize until very recently that you can double-click the home button to bring up all active apps and then close said active apps.  These two changes have improved my phone battery life exponentially.)  But having the phone as the sole data receiver has made me fastidious about bringing a back-up battery charger everywhere I go.  Which is not a new thing, but now feels like a necessary thing.

I had doubts about using the G5 on an airplane, as well, until I remembered that Bluetooth can remain active even when a phone is in airplane mode.  I’ve had a chance to test out the G5 while traveling a few times now and the phone makes a fine receiver even when it can’t make phone calls.  This was a relief.

I haven’t traveled outside of the US yet with the G5, but I’ll be headed to Vancouver for the IDF conference this afternoon, so I’ll have a few days to see how the G5 does when my cell phone has no service.  (I’m guessing Share will be out of commission unless I’m connected to wifi.  Filed under:  No shit, Sparling.)

I really dig the Dexcom Clarity application on my computer.  I know this isn’t new with the G5, but I’ve only been using Clarity since upgrading to the G5, and it’s very nice to see the data living happily on that system.  I like the A1C predictor thing, but have found it a bit fickle.  (“Your A1C looks great today!” … three days later … “Your A1C is crap.  Go directly to jail.”)  I’m still waiting to hear what my actual blood-draw A1C is, so I can’t compare the estimation to the lab work, but I’m curious to see how close those two numbers are.

Accuracy-wise, the G5 does seem to be an improvement.  The data is spot-frigging-on with my Verio Sync results.  No complaints there.

The Parts That Could Use a Shift:

I also don’t like that the alarms on the Share are exactly the same as those on the Dexcom app.  This works great for people like Chris, who follows my Dexcom data through the Share app, but for me, I am responding to my personal alarms and the alarms for the people who Share with me.  I would like the ability to change the alarm noises on my Share app so that when a low alarm goes off, I am positive it’s mine.  In the last month, I’ve treated two lows that were not mine because I responded to the alarm noise instead of checking to see which PWD was actually low.  This is a problem unique to PWD who follow other PWD on Share, but it’s making me feel daft and changing the sound would be an upgrade.

The transmitter is bigger than the G4 one.  I was not as irritated by this as I thought I would be, but when I wear the sensor on my arm, it’s very sticky-outty, and I don’t like more space being dedicated to diabetes devices.  It would be awesome to have the transmitter the size of the G4 one.  Or the size of a grain of rice.  The transmitter also claims to work for three months (instead of the six promised by the G4, which actually ended up being more like 8 months), which means I need to order new transmitters more often.  That adds one more item to the constant “to do” list of diabetes supply crap.

The G5 sensors are the same as the G4 sensors, which means the adhesive is the same as before, which means I am allergic to it.  Toughpads are still required under ever sensor, for me, and with winter almost here, my skin is starting to have its seasonal freak-out.  (The rash is not unique. There is a Facebook group with almost 500 members in it that are comparing ways to mitigate the itch.  Come on, Dexcom — find a way to update your adhesive with as much speed as you’ve done with your data transmission.)

I use an Animas Vibe insulin pump and the G5 does not transmit data to that pump.  So if my phone dies, I can’t switch over to the Vibe as my receiver.  I look forward to when the pumps integrated with Dexcom upgrade their abilities to work with G5.  Until then, it’s annoying to take one step forward with Dexcom while standing completely still with insulin pump technology.

The Parts That Remain the Same:

I never thought I’d see streaming glucose data.  I’m so grateful that I have access to this data because this is the kind of real-time safety net my parents were hopeful for back when I was diagnosed.  I’m sorry they weren’t able to take advantage of it then, but I’m glad it’s here now.

Because otherwise, what would wake me up all night long?  The cats?  That’s so 2005.

Lower Arm Real Estate.

“Rotating sites?  Hell yeah, I rotate.”

… sort of.

I’m good about rotating my pump and CGM (continuous glucose monitor) sites, but I’m decent, at best, about exploring new real estate.  Most of the time, I use my outer thigh or lower back/hips for my CGM, going back and forth between those four areas.  This sounds like proper rotating, in theory, but in practice, I am re-using and abusing the same patches of skin.

Because my skin has a persistent and scaly reaction to the sensor adhesives, it takes several weeks for parts of me to heal after they do their seven days of data due diligence.  Which means that I need to stay the eff away from my last two most recent sensor sites, or else a skin reaction blooms in a matter of hours, regardless of preventative measures.

tl;dr – My skin hates everything and I need new real estate for my diabetes devices.

I’ve seen a few of my PWD friends sporting their sensors on their arms, but until recently, I’ve never been able to keep an arm sensor stuck.  On me, the tape always comes loose and even extra adhesive goes rogue on me.  Arm sensors, up where I used to pinch up and do injections on the back of my arm, are a disaster for me.

But a few days ago, I took a crack at a lower arm sensor, placing it six inches or so above my elbow.  It’s more on the front of my arm (giving my bicep a strangely LEGO’ish look), but so far, so good.  The adhesive is staying put, the Toughpad seems fine, and no skin irritation here on day three.

Above the elbow Dexcom sensor. #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

Placement of sensor on arm. My arm. (Why does this caption sound so formal?! Over and out.) #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on

I’ve been having trouble keeping sensors comfortably stuck in the last few weeks, so I’m hoping a true and proper site rotation helps heal what ails me.  Otherwise, I may scratch my skin into oblivion and will be forced to slather it with Brad Pitt lotion.

[Dexcom disclosures. And all my other disclosures, if you'd like some light reading.]

Whoops.

In almost ten years of using a CGM, I’ve never, ever had this happen.

This morning, when I went to insert a new Dexcom sensor, I followed all the usual protocol:  Put a Toughpad down against clean skin, place the sensor adhesive against the Toughpad, and then insert the sensor right through into my skin, allowing the giant needle to pull back into the applicator, leaving the sensor wire embedded in my skin.

Right?  So imagine my surprise when I pulled back the applicator and instead of seeing a sensor housing ready for the transmitter, I instead saw the stupid needle sticking out of my leg.

“Whoa!”

It hurt, so instead of documenting the needle in my skin (as a good diabetes blogger should – ? – in efforts to get the best grost), I pulled it the hell out and inspected it to make sure there wasn’t anything wrong with it.

The needle in my Dexcom sensor application tool. Filed under "oh hell no." #diabetes

A photo posted by Kerri Sparling (@sixuntilme) on


And you know what’s wrong with it? IT’S HUGE.

EDITED:

The sensor was damaged when the needle gave up on me, leaving the sensor wire poking out from the underside of the transmitter. Pointless prick. :)

Longest Dexcom Break in Six Years.

“Is it because of the skin thing?” he asked, watching me put the transmitter and receiver on the bedroom dresser.

“Yeah,” I replied, only it wasn’t exactly the truth.  Sure, my skin had some pretty irritated patches from the constant application/reapplication of my CGM sensors, but it was manageable, especially if I was more diligent about rotating my sites.  But it wasn’t just the physical itch or the bulk of another device stuck on me.

I needed to fly blind for a while.

Which sounds ridiculous, because I am lucky as hell to have access to that data insight in the first place.  Twenty-some-odd (they’ve all been odd) years ago, I would have laughed in you face if you told me I could have access to all-day streaming blood glucose data without having to prick my finger ever five minutes.  I remember putting on my first Dexcom sensor and being amazed at the trends alone (the old STS wasn’t up to G4 standards).  Using a CGM helped me corral my blood sugars in pursuit of a happy-baby-range A1C without working in a pile of low blood sugars.  And throughout my pregnancy (and the subsequent raising of my now-not-so-small Bird), the data was beyond useful.  It became indispensable.

But after six years of wearing the sensor almost all the time, feeling like the two hour booting up time frame was an eternity, I needed more than two hours off.  I needed more than two days off.  I needed to take the sensor off and put it on a shelf for a week or two in order to stop leaning on it so heavily and to help retrain my body and my mind to tune in more actively to diabetes.

Because when the sensor is on and throwing data, I trust it.  Trust to the point of crutching out on it, not testing my blood sugar often enough throughout the day and making corrections and meal doses off the CGM data.  (Do as the FDA and Dexcom say, not as I do.  Consult your doctor before ever consulting the likes of me.  See also my Dexcom disclosure.)  For years, the CGM data was making me better at the job of managing my diabetes.  I liked it that way, but in the last few weeks (admittedly, months), I haven’t been doing a good job of staying on top of my diabetes.  Instead, I’m letting the technology take control, when the one at the helm should be me.

Took a break.

A photo posted by Kerri Sparling (@sixuntilme) on

So I took off the sensor about a week and a half ago.  Defiantly, but also half-expecting to cave and put another one on right away.  For the first two days, going to bed at night was the toughest part because of my concern for overnight hypoglycemia.  But I was testing more, and I set an alarm one night to double-check, and then there was this moment when I wasn’t panicking about the lack of data because I had started re-trusting my own ability to do this myself.

Because I can do this. I have done this. This Friday marks 29 years of doing it and doing it and doing it well. I’m in control, despite the work it takes to get there and the patchy moments of “Yeah?”

This afternoon, I’ll pop a new sensor on and watch my glucose live-stream again.  But it will be different because I won’t feel like I’m along for the ride with this diabetes bullshit.  I feel a little more like I am back in the driver’s seat, with technology as my seat belt instead of my airbag.

Guest Post: Does Diabetes Tech Assist or Insist?

Several years ago, I “met” DCScribe (who remains mostly anonymous) on Twitter and he and I did not see eye-to-eye on much, aside from sharing the diagnosis of type 1 diabetes.  For a while, the lack of common ground frustrated me because I identify with and bond over experiences, but then I realized the alternative viewpoints he provided were not only important but essential to my growth as an advocate.  It is good for me to hear perspectives outside of my comfort zone; they help keep me realistic.  And when I had the chance to sit down and have lunch with DCScribe several months ago, it was really nice to confirm that two people who might butt heads constantly can still share a mutual respect … and a lunch table.

He was diagnosed with type 1 diabetes at 8 months and has lived with T1 for more than 50 years. Over the course of his career as a journalist, he has worked as a reporter in Washington for 26 years covering the White House and Congress as well as conflicts overseas, hurricanes including Andrew and Katrina, and every presidential election since 1988.  He’s recently embarked on a new career in global health that will take him to the frontlines in the battle against Ebola, malaria, AIDs and other scourges around the world.

And today, DCScribe is taking a turn here at Six Until Me to talk about diabetes technology as something that assists or insists.  Read on for more.

*   *   *

The older I get the more I’m struck by how the decisions I make in so many facets of life are deeply informed and influenced by my long career refereeing soccer at the highest levels.  It’s even shaped my relationship with diabetes technology. And yeah, I can hear the rumbling. “Holy hell. Where’s this going? That dude ought to check his ‘sugar.’”

But it does. And here’s why. Reffing has helped me understand the difference between someone (or something) who “assists” and someone (or something) who “insists.”

It’s a question every diabetic should ask when making a decision about the technology you need (and don’t), how to use it and whether it means being in control or under control. Understanding where that line falls and enforcing it is central to my D management and my easy, stress-free life with the disease.

I speak only for myself, of course, and concede there might be gaps in my perspective. After all, only two other people outside my wife and kids and my doctor knows of my condition and my identity. My wife knows I use a pump but doesn’t know the brand or really how it works. I never share my BGs with anyone, though I’ll offer vague updates at home such as, “I’m gonna wait a bit to eat dinner.” It works for me; I’ve never had a single bad day from diabetes in more than 50 years. Sure, some days are better than others but not one has been truly bad or difficult.

There are lots of reasons, but an important one is my comfortable but always skeptical relationship with technology.

I have no idea if I’m different in that respect. But from scanning the Diabetes Online Community twitter feed and beyond, I wonder if enough people asking the question about technology’s proper place and power. (Here’s one place where it was asked and discussed publicly. It’s a cautionary tale and luckily I can’t ever imagine finding myself in a similar place.)

At the same time, I’m not immune from the pull of technology. I use a pump and have for 16 years (though my current pump is 7-years-old. Let’s face it: a pump is little more than a tricked-out syringe.) It’s why I got my first blood glucose meter in the 1970s and have used one ever since (though my one-and-only meter today is 9-years-old.) It’s why I’ve never used a continuous glucose monitor and never will. I’m constantly examining that distinction and that, along with my natural skepticism keeps me from chasing the latest, often imperfect, shiny object until its use and accuracy are proven.

This also fits with my belief that too much information can be more of a burden than a savior, especially if that information is imperfect. I wonder too if a fixation on technology diverts attention from proven and powerful “human factors.” For me, the basis of my success and easy life with D is rooted in discipline when it comes to food, making sure I’m physically fit and a refusal to ever use diabetes as an excuse for anything at any time.

Which brings me back to the beginning and “the pitch.”

In soccer, most games have three refs (though in a lot of my games there’s also a Fourth Official.) The Center Ref is the only one with a whistle. He or she prowls the entire field and is the one person responsible for fair play and safety; for keeping the official game clock and chaos to a manageable level. The Center Ref is the ultimate and singular authority. All decisions start and end with him or her.

The Center Ref uses his or her experience, training, knowledge and physical fitness to manage the game, navigate nuances and the many “gray areas” woven into the Laws of the Game and to ensure the rules are applied in a fair and consistent way.

But the Center isn’t alone. Along for the ride are two Assistant Referees, one on each sideline. Without ARs, the Center’s job is difficult if not impossible, especially on a regulation field that measures 120 yards by 80 yards.
The ref crew is a team in the truest sense, but to work well, everyone understands this: Good assistant referees never “insist.” Their job is to “assist.” That means there are times when the Center Ref will wave down a flag (or tell an AR through the headset) because the Center Ref is in a better position or has more experience or a different understanding of the larger picture.

Replace “AR” with “diabetes technology” and you get the idea.

That’s why I seldom follow the number my bolus “wizard” spits out. Its why, when my meter says I’m 70 mg/dL and I’m getting ready to ref a game that will require running upwards of seven miles and demand thousands of decisions, including a few that are game critical, I don’t hesitate. I appreciate my meter’s “assistance,” jam a granola bar in my mouth, wash down with a gulp of sports drink and go. But not always. Sometimes I simply walk on the field and start the game.

I seek assistance in carefully chosen places. That makes perfect sense to me. It doesn’t mean I’m anti-technology.

I’m a guy, so I’m hard-wired to get all tingly from even most dubious technological “innovation.” It should be no surprise that I would have instantly given up insulin before surrendering my satellite phone or the solar charger for my up-armored laptop when I was reporting overseas. In the early 1980s I had a very public and very serious relationship with my 30-pound Teleram “portable” computer that I happily lugged from one corner of the country to the next so I could transmit stories to the Mothership at the wondrous rate of 1,200 baud per minute.

And yet, I still use a 5-year-old iPhone and have zero urge to change because … it works.

Technology is great. I love it. I use it – a lot of it. But skepticism is more useful for me, as is enough patience to make sure the latest, greatest bit of technology works as advertised, and that whatever tech I use in my ride with diabetes knows its place, no matter how hyped or magical or shiny.

*   *   *

Thanks for your perspectives, DCScribe.  And for the link to the oldest computer ever. 

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