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Posts tagged ‘dexcom’

LEGO Easter Robot.

Easter morning dawned bright and early (with a confused little Bird wondering about the strange relationship that appeared to be in place between her parents and a giant bunny).  Egg hunt, breakfast, and then off to visit relatives throughout the day.

Easter has always been one of those “Sunday best” holidays in my family, where people dust off their dresses and shirt-and-tie ensembles and work a higher octane look for the holiday.  I like this tradition.  I like dressing up once in a while.  (It’s a stark contrast to my work-from-home attire, which only includes a nice shirt on the days when I have a video conference call … notice I didn’t mention anything about nice pants.)

But holy eff did I want to throw out every single diabetes device yesterday and go back to shots for a few hours, all because of one, stupid dress.

The dress I wore didn’t have any pockets.  It was a fit-and-flare style dress, which meant that it was cinched in a bit at the waist and didn’t leave a lot of room for my insulin pump to be stashed in the waistband of my tights without looking bulky.  And the disco boobs route wasn’t a good fit, because the dress was fitted in such a way that the pump looked like a giant LEGO stuffed into my dress.  My Dexcom sensor kept getting caught on my tights (I wear the sensor on my outer thigh) and looked again like I was infusing LEGOs to random parts of my body.

I was the LEGO Easter Robot, and it was frustrating.

But despite my fashion-related bitching, it was better for me to keep devices on this time, instead of trying to make the flip to MDI (multiple daily injections) for the day.  Despite eating several times throughout the day and indulging in foods that are historically rough on my blood sugars (read: Peeps), my blood sugars stayed reasonably in range, and I was able to stalk my numbers on my Dexcom graph.

Sometimes it’s better for me to embrace being a robot.

Binge-Watching Causes Low Blood Sugars.

Dead Poet’s Society.  It might be a film from 1989, but it remains one of my favorites largely in part to Josh Charles as Knox Overstreet.

(He doesn’t care that Chris is with Chet.  Carpe diem!  And there’s a point to this – stick with me.)

Chris and I don’t watch a lot of television, but we have been swept up in the whole binge-watching phenomenon afforded by outlets like iTunes, Netflix, and Amazon Prime.  Even though we were late in getting into Breaking Bad, we caught up last year in a hurry just in time to immerse ourselves into the broadcast of the second half of season five (technology, bitch!)  We didn’t watch The Wire when it was originally broadcasted, but we did rip through five seasons of that show in a hurry.  And we finished True Detective last night (even though I will admit that I didn’t catch everything everyone was saying because the mumbling was oh my).  Binge!!

But we don’t watch every show together. The Good Wife, which I’ve just recently started watching while doing longer, steady cardio workouts at the gym, is my go-to show to watch solo.  Which brings us back to Knox Overstreet, because he’s a lead character in The Good Wife.  And for at least 40 minutes every day, for the last two weeks or so, good ol’ Knox has been helping me earn my steps for the day.

Last week, though, I made the mistake of trying to binge-watch at the gym and mistakenly lost track of time and blood sugars.  Instead of taking a peek at my Dexcom every ten minutes or so, I totally spaced.  Which meant that I did an hour of walking/running “blinded.”  I should have checked my blood sugar.  Instead, I walked to the car in a staggered pattern, not unlike Billy from Family Circus, unlocking the car door and haphazardly throwing all my junk onto the passenger seat while simultaneously fumbling for my glucose meter.

“Yes, I’m sure you’re right,” in response to the triple BEEP BEEP BEEP! of my Dexcom receiver, throwing rage from inside my gym bag.  My glucose meter confirmed the tri-beep with a blood sugar of 33 mg/dL.

It’s funny (not really) how the symptoms are dammed up until I see the number, and then once I am aware of my actual blood sugar, the dam gives and hot damn, panic hits.  My car, for a brief moment, looked like I let a glucose tab dust genie loose from its lamp as I worked through five glucose tabs.  I sat and waited until the feeling came back to my lips and my hands stopped shaking, then checked my blood sugar again to make sure I was okay enough to drive home.

The lesson learned?  If I’m going to spend more than my fair share of time watching Knox Overstreet woo Nurse Carol Hathaway, I need to watch my Dexcom graph closely.  Binge-watching is apparently the leading cause of Sparling low blood sugars.

 

Hypo Unawareness.

There are times when I think that maybe my hypoglycemia unawareness is made up, or all in my mind, or that it’s overblown and exaggerated.  “Pfffft, you can go without a Dexcom for a few hours, because you’ll totally feel any lows that crop up,” is the mantra that runs through my head when I pull a sensor off and see scaly skin, knowing I should wait before even going near the skin with another sensor.  (The Dexcom adhesive/sensor rash isn’t entirely better, but mostly better. The Toughpad underneath the sensor holds it for at least seven days, and more often than not, I’m able to go approximately ten days per sensor.)

But the thing is, I shouldn’t let things go that long.  I should be pulling the sensors at the seven day mark, to avoid mangling my skin and forcing myself into brief CGM hiatuses.

I tend to wear my sensors in the same region of my body (outer thigh), where there is enough real estate to work with, but not enough to work with exclusively.  The time between sensor reapplications, whether it’s a week or more, isn’t enough time for my skin to fully heal.  Sometimes a skin reaction doesn’t occur and the skin that was trapped underneath the Toughpad for a week is still unmarked and supple, so I can stick another sensor in whenever I’m ready.  Usually, regardless of how the skin looks when I pull off a sensor, I rotate to the other thigh and try to pick a different insertion spot, just to keep things on the up and up.  And sometimes, even when the skin looks good after I pull a site, it sometimes turns red, prickly, bumpy, and scaly a day or two afterwards, and remains scaly for several days.  (I apply this Curel lotion to my scaly skin and it helps quite a bit.)


I have trouble – lots of it – pulling a sensor off simply because it’s hit the seven day mark.  If that sensor is stuck, and the results are good, I want to leave it on as long as possible.  I feel like the longer a sensor is on, the more accurate and precise it becomes.  Days 8, 9, and 10 are always spot-on and I feel confident in the results because they not only match up with my meter for spot-checks, but they consistently match up.  Seeing more than a 15 point spread between my Dexcom number and my blood sugar meter check is a rarity in those date ranges.

Frustrating, to say the least, to pull of a sensor that seems to be working just effing fine, thank you very much.

I need to take better care of my sites, because for every long sensor shelf (leg?) life, I’m paying for it on the other side with scaly, un-useable skin.  Which equals out to needing to let the sites breathe for even 18 hours or so every few weeks.

Which ends up resulting in moments like this today:  Sitting in the parking lot at the bank, chewing and swallowing glucose tabs as fast as I can because the blood sugar of 41 mg/dL came out of no where and the only reason I even tested my blood sugar before driving home was because Birdy asked me if she could have a snack and I wanted to have a snack, too.  I had no idea my blood sugar was tanking.  Even in retrospect, the only symptom I had was a clumsy fumble for my meter in my purse, but I initially blamed the fumbles on cold hands.

I chomped the hell out of those glucose tabs – not out of shaky, panicky hypoglycemic symptoms, but the lack thereof.

 

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 …

*   *   *

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.

*   *   *

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.

Endless Lows.

I do not know what makes them stick like this, the lows that creep in and stay creepy for hours at a time.

“Is this thing serious?” I asked.  Then I’d prick my finger to confirm that, indeed the Dexcom was serious, and I was in fact still low.

There are times when high blood sugars are stubborn and refuse to come down, even when I rage bolus and exercise.  But I can tolerate a sticky high because, even though it’s not comfortable, I can still function properly-ish.

The endless lows, though, work me over in a way that’s entirely different.  Last night, I came home from the gym with a downward drop in my Dexcom, and it lasted for two and a half hours.  Which meant that, for two and a half hours, I had a combination of numb lips/tongue, shaky hands, mental fogginess, and that urge to cry without reason.  I had to constantly tell my daughter, “I just need a few more minutes, because my blood sugar is low.”  I was thankful that Chris was home to help me negotiate parenting stuff/reminding me to eat something else.

What makes this happen?  How can I chomp down ten glucose tabs and a banana and some applesauce over the course of three hours and barely see a blood sugar budge?  It took over a 150 carbs to make a dent (And that dent peaked up to 200 and then promptly fell again.  What the eff?).

“What are you now?” Chris asked before bed.

“202.  And I’m fine with that,” I replied with finally-not-numb-lips-and-a-shirt-collar-dusted-with-glucose-tabs.

Diabetes Art Day Outtakes.

Before we settled on paper dolls for Diabetes Art Day, there was an unnatural exploration of cats and a finger painting app on the iPad (don’t read that sentence too fast or it will give you an unintended mental image).  This is what happens when the snow keeps falling and it’s far too heavy and constant to shovel so you’re stuck at home, taking art direction from a three and a half year old:

“How about we put the pump on Siah?”

“Sure, like this?”

“Yeah, only the tubing is across her belly button and she’s going to get stuck to the doorknob for sure.”  (Birdy doesn’t know much about diabetes, but she knows I end up tethered to things more often than I’d like.)

“Hey, is that Siah’s Dexcom?  On her leg?  Like you wear!”

Silence.

“I don’t know what any of that is, Mawm.”

“That’s Siah.  She’s wearing a blue circle pin for World Diabetes Day.  And behind her is …”

“Jail!”

“Nope.  A calendar.”

“We need one with Loopy.”

“Okay.  Here’s the Loopster with some glucose tabs.  And glucose tab dust all over her fur.”

“Whoa blood sugars are dusty.”

“Yes they are.”

If I Knew Then: Continuous Glucose Monitoring – Dexcom.

I tried my first CGM system back in 2006 (this post outlines the very first awkward sensor application) and have spent the last seven years or so being thankful that this technology exists.  If I knew then what I know now … actually, I started on a CGM as quickly as I could, and stayed on it.  Why I wanted a CGM is an easy question to answer, but there are a few things I wish I had known before starting out:

I wish I had known that some of the sensors would hurt.  So many diabetes devices are branded with “pain-free!” and “barely feel it!” advertising taglines, which I think is crap.  We’re talking about a needle that pierces your skin and leaves a wire behind, underneath your skin, for a week at a time.  To think that every sensor will glide under your skin with barely a whisper is bullshit.  Some of the sensors hurt like hell when they go through my skin, and sometimes it takes an hour, or a day, for the site to settle down and not feel so tender.  But most often, it is a reasonably quick pinch and then reasonably painless for the duration of the wear.  Your mileage may vary with each and every sensor.

I wish I had known the data would be addictive at first.  The first time I wore a Dexcom sensor, it was back in 2006 and was one of the first marketed versions of the system.  But I was hooked on the data.  I looked at the receiver every five minutes and went bonkers trying to make sense of the trends.  The trouble was that the readings were far less accurate back on the Dexcom STS, but I took them as seriously as the numbers on my glucose meter.  For the first few weeks of wearing the Dexcom, I drowned in data, obsessively checking it and chasing slight blood sugar climbs with aggressive correction boluses.  I needed to learn to let the data flow into my management, not change the flow of my management.

I wish I had known I would go through a data burnout – and that’s okay.  After I gave birth to my daughter, I went through some post-pregnancy burnout (adjusting to motherhood put my diabetes on the back burner for a few months) and for several weeks, the Dexcom was used to monitor my overnights (watching for lows), but not much else.  I wasn’t in a mental state to micro-manage my numbers, and instead I needed the Dexcom graph to confirm that I was at a stable enough blood sugar to take care of my kid.  The data was too much at times, and I frequently turned off the high alarm because it BEEP!ed relentlessly.

I wish I had known that thresholds were individual choices.  Everyone manages their diabetes in a different way, and even one, single person can have varying styles and preferences.  For a few years, I wanted to see my blood sugars between 60 – 220 mg/dL.  When I needed/wanted tighter management (pre-pregnancy and pregnancy), my thresholds were between  60 – 140 mg/dL.  And now, I keep my high alarm set at 140 mg/dL.  I like knowing when my blood sugars go over 140 mg/dL because that gives me a chance to head them off at the pass and keep them from climbing into the 180′s and 200′s.  Some people roll their eyes at wide thresholds, while others judge for not having the lines “tight enough.”  Where you set your CGM alarms is a personal decision and one that needs to work for you and your medical team.

I wish I had known, and had been ready to accept, the fact that wearing a second device was going to be a pain in the ass.  I wear my sensor on my outer thigh and the bulge is pretty obvious at times.  When I go running, you can clearly see the outline of the sensor through my running pants (and you can almost read the word “Dexcom” through running tights).  In a more fitted dress, the lump on my thigh is unmistakable.  And sometimes if the sensor is a tough too high or too low, it’s right underneath where the pocket of my jeans sits, making it feel particularly lumpy and awkward.  Of course, there are plenty of times when it’s barely noticeable, if at all.  (And it’s always fun, and a bit cheeky, to talk about “the bulge in my pants.”)

I wish I had known that I would eventually learn to trust the algorithm.  At first, I had to learn how to use my CGM, and I had to let the transmitter “learn” me.  The numbers I saw, when compared to my meter back in 2006, weren’t close, but I needed to understand that the CGM provides trends, not exact blood sugar results.  (The thing doesn’t even test blood sugar, but instead interstitial fluid.  Knowing that, however, still doesn’t make me want to throw all technologies across the room when the meter and the CGM are 100 points apart.)  And even now, using the most recent iteration of the Dexcom system (the G4 Platinum), the results are almost spot-on with my meter, but I need to remind myself to test my blood sugar to confirm how accurate the CGM is now.

I wish I had known that there could be an allergic reaction to the Dexcom sensors, but that it could be managed with someone as simple as a high-tech bandaid.  After spending months dealing with a very volatile rash caused by my skin reacting to the Dexcom sensor adhesive, a reader suggested that I use a Johnson & Johnson Toughpad underneath my sensor.  This simple solution worked to cure my Dexcom rash.

I wish I had known that the information I (hunt and) gather from my Dexcom data has made my diabetes easier to wrangle in.  Sure, the thing alarms all the time and yes, wearing a device isn’t ideal.  But when it wakes me up in the middle of the night because my blood sugar has dipped below 60 mg/dL, or when I can check it before driving and see, with confidence, that my blood sugars are stable before getting behind the wheel?  For me, that makes any and all of the inconveniences worth it.

What did you wish you had known, before trying out a CGM?

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