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Posts tagged ‘dexcom’

Stress!!!! and Diabetes.

Do your blood sugars respond to food?  Of course.  How about to insulin?  And exercise?  A big “hell yes” to those, too.  Food, insulin, and exercise have tangible influence on my blood sugar levels.  But one influencer that I don’t often take into account is stress … which is a ridiculous variable for me to ignore because stress can make my blood sugars leap over tall basal rates in a single bound.

Oh look – a video!

How does stress change the mapping of your blood sugars?

The Last Straw.

“Mommy … I had a nightmare.”

She shows up in the middle of the night sometimes, evicted from her warm bed down the hall due to a nightmare.  “I had a dream about a blue monster with no arms and popcorn on his feet.”  She’s clutching her blanket, her water, a flashlight, and a stuffed animal; clearly she’s in for the long haul.

I moved over in the bed and she started to climb in.

“Oh and mom?  You’re low,” she said, handing me the vibrating pump.

The fog of feeling sleep lifted immediately and I recognized the symptoms of this hypo.  Sweaty hairline, fumbling fingers, my sight reduced to a tunnel, and my hearing razor-sharp, hearing the shuffle of my daughter’s feet, the steady breathing of my sleeping husband, and – finally – the buzzing buzzery of my CGM alarm.

“Do you need something?” Chris asked from beside me.

“Yeah – can you grab one of those juice boxes from the shelf?”

Birdy was already snuggled in beside me, nestled close against my hypo-damp shoulder.  A few seconds later, Chris returned with a juice box in hand.

Habit, habit, habit – I am a creature of it.  When my blood sugar is low, I go through the motions to treat it, and if anything gaffs up the routine, I’m thrown.  Lows in hotel rooms rock me because the bedside table is five inches farther from me than at home.  When I am home, having the glucose tabs on the table itself instead of in the drawer can be enough to confuse me thoroughly.  (Lows make me the least-sharp knife in the drawer.)  In this case, I grabbed the juice box firmly and reflexively used my other hand to reach for the little plastic sleeve with the straw tucked inside.  Only I grabbed it a little too firmly and juice shot out all over the bed, because my forward-thinking husband had already stuck the straw inside the foil hole.

“Shit …”  My pillow was wet with juice.  And so was my daughter, because I managed to (ocean?)-spray her in the face during this transaction.  “I didn’t know the straw was already in there.”

“Do you need another juice box?”

“No, this should be okay.  Only a little bit flew out.”  I drank the rest of the juice box, per routine.

“MOM. This is not OKAY.  I am all WET.”  (Even at 3 am, my kid can be indignant.)

“Sorry, baby.  You can go back to your own bed, if you want?  That bed doesn’t have juice in it.”

She thought for a minute, then buried her head under the blankets to issue a muffled response.  “No WAY.  The monster had popcorn feet.  NO WAY am I going back to my bed.”

 

 

Practice Turkey.

Chris and I are both from big families with piles of aunts and uncles and cousins at every birthday party.  Part of being part of a flurry of people means big holiday gatherings, and Chris and I are prepping ourselves to start hosting some of the holidays.

Problem is, I’m a terrible cook.  Or, better stated:  an inexperienced cook.  Cooking hasn’t ever brought me joy or satisfaction, and I’m not interested in the time it takes to perfect a recipe.  I cook for form and functionality (read: make sure my family doesn’t survive on garlic salt and overripe bananas), not for fun.  I’m not good at making the effort to learn.

But if we want to start hosting holidays, we need to learn how to prepare some of the main courses.  Which brings me to the Practice Turkey:

Practice Turkey is currently taking up residence in our freezer, and my goal is to use him to teach myself how to properly prepare a whole turkey.  (Sidebar:  Animal is in our freezer because Birdy is afraid of him, but refuses to let us donate him or throw him out.  She wants him in the house, but entirely contained.  So he lives in our freezer and has been there about a year.  I always forget that he’s in there, until someone comes over to visit, opens the freezer, and subsequently goes, “OOH!!”) In the next week, my plan is to practice my culinary witchcraft on Practice Turkey so that when we host holidays this year, I’m not in a huge panic because I can be all, “Oh, the turkey?  I know how to do that.  I’m all over that!”

I need to actually do it in order to make sure I can do it.

Same goes for technology hiccups in my diabetes management plan.  I use an insulin pump and a CGM (hellooooo, disclosures), and with that convenience and data comes an influx of autonomy and the sacrifice of my autonomy, if that makes sense.  The devices give me a lot of flexibility and freedom, but if I rely on them too heavily, I forget how to manage my diabetes on my own.

I need to be my own Practice Turkey, relearning the details of diabetes.  I need to make sure I know how to calculate a bolus, check my blood sugar regularly by finger prick, and finagle basal insulin doses if my pump ever breaks, or if I ever want to take a CGM break, or if my will to wear devices breaks a little.  And over the last week, I’ve been on a bit of a device break (thank you, winter skin issues), realizing once again that a refresher course on how to drive the stick-shift version of my diabetes (so to speak) helps me take better care of myself overall.  Taking an injection before I eat makes me think twice about the food I’m putting into my body, and also help me remember to pre-bolus (because it’s a process, not just the push of a button).  Using the treadmill instead of a correction bolus to fix a 180 mg/dL keeps exercise fresh in my mind.  3 am checks aren’t always necessary, but doing a few of them helps me spot-check my overnight basal rates.  I appreciate my devices, but I needed a reminder on what they do for me, and how to continue to do for myself.

Practice (turkey) makes perfect.

[Also, today has been unofficially designated as a “day to check in” (hat tip to Chris Snider) with the DOC blogs that we’re reading.  I read a lot of diabetes blogs, but I don’t often comment because I usually want to say something meaningful, instead of “I like your post.”  (But I do like your post!)  But instead of finding that meaningful comment, I usually roll on and forget to return to comment.  NOT TODAY!  Today I’m commenting on every blog I read, because that’s the name of the game.  I love this community, and today I’ll show that through comments.  So please – if you’re here, share what your favorite word is, or just say hello.  And thanks for being here.]

It’s a Good Tune.

“BEEEEP … BEEEEP… BEEEEP!”

“Mom, your Dexcom is making noise,” my daughter says casually, as we’re kicking the soccer ball around in the basement (because we’ll never, ever go outside again because snow).

“It is. Hang on a second,” I told her. A click shows that my blood sugar is over my high threshold, with a few yellow dots taking up residence on my graph. I’m not totally worried, though, because a check of my pump reveals some insulin still on board. I decide to let things play out and see where I land a bit later.

“I’m fine, kiddo. Let’s keep playing.”

The Dexcom has been part of my daughter’s life for as long as she can remember. When she was very small and figuring out her letters for the first time, I remember her running a tiny fingertip along the bottom of my receiver – “D-E-X-C-O-M spells … whaasat spell, Mama?”

“Dexcom. That’s the name of the machine.”

(Unlike most kids, my daughter’s list of first words included “pump,” “Dexcom,” and “diabeedles.” Maybe she’ll grow up to be a doctor? At the very least, this knowledge base has given her a leg-up on winning a few topic-specific spelling bees.)

As Birdy grew older, she started to understand some of the information that different diabetes devices provided. We’ve talked a little bit about how three digit numbers on my glucose meter that begin with “2” most often require me to take some insulin from my pump (same goes for the ones that begin with “3,” only those also come with some curse words), and how when the Dexcom makes an alarm sound, I need to check it and take some action.

“But that alarm – the BEEEEP … BEEEEP… BEEEEP! one – is one we can ignore, right Mom?”

“Ignore?”

“Yeah. When it goes BEEEEP … BEEEEP… BEEEEP, you don’t always look at it. But when it goes like this,” she raises her hands up in front of herself, like she’s sneaking up on something, “BeepBeepBeep really fast, then you look right away and get some glucose tabs.”

Funny how much she notices, how much of my diabetes self-care ritual has become a natural part of our time together.

“Kind of. The long beeps mean my blood sugar might be higher, but it’s not an emergency. The short beeps mean I have low blood sugar, and I need to get something to eat so it doesn’t become a big deal. Does that make sense?”

“Yeah.”

The sounds of the low and high alarms ringing out from my Dexcom receiver have become familiar, like a subtle (and sometimes not-so-subtle) soundtrack for my diabetes life, but I didn’t realize until recently that they are also sounds that remind my daughter of her mother.

The other morning, I heard Birdy walking into the bathroom to brush her teeth, and she was humming a little tune to herself, one that I recognized.

“Hey you. Are you singing a song?”

“Yeah. It’s the Dexcom beep song. It’s a good tune.” She grinned at me, toothbrush hanging out of her mouth.

Animas Vibe: A Few Weeks Later.

Again, disclosure:  I work with Animas and have a sponsorship contract.  Here are more details on my disclosures. And this is the Mr. Plow theme song.  Mr. Plow would be great, about now, since the snow keeps dumping down outside.

It’s been several weeks since I’ve switched to the Animas Vibe insulin pump (with integrated CGM technology – doesn’t that sound like a rehearsed phrase?  How about “insulin thing with CGM thing built in and have you seen my coffee, pleaseandthankyou.”), and I thought I’d take a crack at some second impressions, since the first impressions were only compiled after a few days.

Talking ‘Bout CGM:  I am still into the concept and application of having one device that does the work of two.  While the Vibe still requires that I wear an insulin pump infusion set and a CGM sensor as two separate insertions, it removes the need for an external CGM receiver.  I wrote about this last time, but to reiterate:  I am okay with not using the separate receiver.  I’ve traveled a lot in the last few weeks and the first few trips, I brought along my CGM receiver so I could plug it into the SHARE port.

For the record, I still haven’t upgraded to the 505 software.  Judge all you want.  :)   Which may explain my identical CGM graphs.  (And, also for the record, I’m really, really excited to see the new Dexcom receiver.  That may change how I feel about clouding, as it would be much simpler.)

But then Chris and I came to realize that we aren’t good at this whole “data sharing” thing.  As much as it sounds like a good plan in theory, we aren’t good at the application of it.  I think this becomes a patient-specific preference sort of thing, and for this PWD, I’m not a data-sharer.  But as I mentioned with that previous dead horse that I keep flogging, I like options.  Love them, actually.  And anything that gives data options – LIFE options – to people touched by diabetes, I am all for it.

(That sentence was a grammatical nightmare.  Ignore the sloppy parts and move on, yes?)

DiasendYesterday, for the first time in a long time, I downloaded (uploaded? loaded.) my data to Diasend.

The data collection portion is cumbersome.  I hate dongles and charging cords and all the extra beeps and wires required to make sense of diabetes data.  (Which is why I’m such a fan of the Verio Sync idea, which uses bluetooth technology to automagically suck the results off my meter and spit them into my iPhone, but there are issues with that system, too, because it’s only iOS compatible.  Pluses in one way, minuses in another.  But see aforementioned “I love options” sentiment, because it still applies.)  But I did download my pump data, which also downloaded my CGM data.  And, because I was feeling ambitious, I uploaded my glucose meter, too.

So this was my first time looking at Diasend with information about my insulin doses, glucose meter results, and CGM results on the same screen.  (No, I am not sharing my results.  My numbers have been absolute shit lately and I’m not going to pepper my blog with confirmation that I have diabetes.  I’ll let the c-peptide test that’s required by my insurance in order to cover my insulin pump serve as that confirmation.  Yes, that’s a thing.  Yes, more on that later.)

Diasend is good for granular information, but the information on the “compilation” tab was ace for me.  Seeing my blood sugar averages based on time of day was powerful.  (I have midnight to 11 am nailed and awesome.  Everything not in that time frame needs a solid snuggle these days.)   As a Mac user who hasn’t explored the new Dexcom/Mac Portrait (I’m woefully behind on everything that doesn’t involve Birdy these days), seeing my Dexcom data on my laptop is amazing.  I’ll be exploring Portrait in the next few days but in the meantime, I’m happy that information can be siphoned over to Diasend.  And it puts the constant flow of data into digestible context.

Pump Stuff.  Since I was a Ping user before, using the Vibe feels familiar and easy.  I’m still glad this sucker is waterproof and the button clicking process is familiar to me.  All of that feels the same.  One thing I have noticed is that the more my CGM needs attention, the faster the battery in my pump needs replacing.  This is annoying, but makes sense despite the annoyance.  For the first time ever, I’ve invested in lithium batteries for my pump and it seems to hold much better than the alkaline ones I have been using for the last … forever.  But overall, the pump feels familiar and comfortable, and since I hate change, that familiarity is a plus for me.

Alarms, for whatever reason, remain easier to hear and feel when they are coming from the pump.  This was a huge concern of mine because I thought the pump alarms would be muffled by clothes and bedding, making them hard to catch.  But I actually respond to low and high alarms more readily on the Vibe.  I am not sure why.  Maybe because it’s attached to my hip and I feel the vibration?

What remains to be seen is how the changing state of Dexcom progress will affect my feelings about this pump.  Right now, it’s the only one integrated with the CGM I already use, so that’s a huge plus.  But I am concerned about the fact that the software in the Vibe is already behind on the current Dexcom system.  I know the FDA process creates hurdles that are hard to clear, but since the Vibe has already cleared the Big One, can I expect that updates and upgrades will come fast and furious?  As a PWD using the Animas product, I hope this is the case.

And lastly, I’m hoping to have this pump covered by my insurance company.  I’m still trying to get a c-peptide test done (travel, snow, and issues with fasting) to fulfill the requirements issued by Blue Cross Blue Shield, so that journey remains ongoing.

Thankfully, I’m still pretty effing sure I have diabetes.   So yay?  Yay.

Animas Vibe: First (and Quick) Impressions.

Again, disclosure:  I work with Animas and have a sponsorship contract.  Here are more details on my disclosures.  I link to my disclosures more than I link to cat .gifs, which is saying QUITE A BIT.

As I mentioned, I’m testing out the Animas Vibe.  Here are my first, quick impressions after a few days using the Vibe.  (What, you wanted some long, flowery introduction paragraph?  I’m out of words.)

First things first. Change can be awkward and uncomfortable.  When I switched from Medtronic to Animas back in 2010, I had trouble with the switch not because of the pumps themselves but because of the change, in general. Wearing an insulin pump means being connected to a small box and tubing 24 hours a day, so you really get to know that box/tubing combination.  The curves and edges of the pump  became something I knew by heart, and wearing a pump that was even half a millimeter different than whatever I was used to made me grouchy.  It took me about three weeks to become used to wearing the Animas Ping pump, and about a month and a half to become entirely used to the differences in filling the reservoir, changing the infusion set, responding to alarms, etc.  (I experienced this all over again when I took the t:slim pump for a spin over the end of the summer.  The pump itself was fine but the different size/shape/process made me grumpy like this cookie and I was less accepting of the pump because it wasn’t what I was accustomed to.  This isn’t a comment on which pump is superior, but a commentary on why the learning/acceptance curve, for me, is a true curve.  It also illustrates my hate for change.)

I was set up on the Animas Vibe on 12/31, so I haven’t had this thing for more than a few days, but going from Ping to Vibe was simple in terms of learning curve because I’d already done that curve.  I have worn an Animas Ping since 2010, so the routine is familiar.  Keep that in mind as you read through my perceptions, as they are colored by familiarity.  And coffee.  (I had two cappuccinos with dinner.  TWO!!  Bees in fingers [h/t CSparl].)

CGM Integration.  I was unsure how I’d feel about integration, to be honest.  I like having my Dexcom separate sometimes, and things like CGM in the Cloud and Share are important to me because I most-often travel alone, so having my data streaming to the cloud is an important safety feature.  But, on the whole, I don’t stream my data (with overnight exceptions as noted).  Basically, I am the main person who needs access to my data.

However.  (And this is a big however.)  I like, and appreciate, options.  I don’t have the option of ditching diabetes, but I do have options on the tools and technology I use to make sense of diabetes.  I LOVE having the Dexcom data showing up on my pump screen.  Love, love, love.  Why?  Because I always have my pump clipped to me.  I didn’t realize, until a few days ago, how often I was keeping tabs on my external receiver, bringing it from room to room with me, and keeping it clipped to my purse while I was out of the house.  I went for a run the day that I hooked up to the Vibe and it was exciting to bring only one device with me.  With a tube of glucose tabs in my pocket and pump clipped to my hip, I was good to go.  It felt liberating.


The best part, for me, is that I can run my separate Dexcom receiver at the same time.  Yes, they can run simultaneously.  (No, I have no idea how that impacts the battery life of the transmitter.  Nor am I certain this is a sound idea.  But I’m doing it anyway.)  Both the Vibe and the receiver need to be calibrated separately, but for the times when I’m away for work, I’m happy I can still make use of the Dexcom Share without getting all weird. Options where there once weren’t any at all; I’ll take it.

(And I haven’t had a chance to test the accuracy of the receiver vs. the Vibe, but since I haven’t yet upgraded my receiver to reflect the 505 algorithm [we don't have a PC], I don’t know if my comparisons would be best.  Once I hijack someone’s PC and update my receiver, I’ll circle back on this.)

One concern I had about integration was whether or not I would hear the alarms on the pump.  In setting up my pump, I customized my alarms to reflect a vibration for any low blood sugars and a beeping for any highs, thinking that a vibration would be good for middle-of-the-night low warnings.  While I haven’t had much time to test the highs and lows (thankfully, numbers have been reasonable for the last few days), I did have one 2 am low blood sugar and the vibration woke me up.  I’ll have to wait a few more weeks/months to truly test how responsive I will be to the alarms.


Graphing it.

A photo posted by Kerri Sparling (@sixuntilme) on

One other concern I have is about the color indications for the different numbers.  I’m a creature of habit (see above bit about hating change) and I am used to the way that the Dexcom G4 receiver lays out blood sugars, in terms of color.  Ketchup and mustard, you know?  Highs are yellow, lows are red, and white means don’t touch anything because in range.  However, since companies cannot sync up their shit in a way that makes things easiest for end users (aka the PWD), the CGM graph on the Vibe is entirely different than that of the G4.  On the Vibe, highs are red, lows are blue, and in range is green.  For me, this has been a weird change because I like at-a-glancing at my CGM throughout the day, and now I need to readjust my mindset for what “red” means.

Screen Resolution.  This might seem ridiculous, but there’s a new feature on the Vibe that allows for the brightness to be turned up/down with a click.  The button on the edge of the pump with the little lock (or lightbulb, or whatever that icon is)  makes whatever screen you’re on brighter, or less bright, with a click. I like this more than I should, I think.

Food Database.  I haven’t used the Ping meter in a few years (I switched to the Verio when it came out, and am now using the Sync), so I haven’t done much with the food database in the past.  On the Vibe, the food database is built into the pump, so if I go in to give a bolus and use the EZCarb bolus, I can access a customizable database on the pump itself.  I haven’t had much time to play around with this feature yet, but I plan to as I fiddle around with the pump.  (One note:  on the “snack” screen, the food options are all junk food.  Chocolate cake, cannoli, donut holes, key lime pie, just to name a few.  Who categorized these as “snacks” instead of “junk food”?  Confused the small, rational part of my brain.)

To that same end about not using the Ping meter for a while now, it’s important to note that the loss of meter remote capability in the Vibe vs. the Ping did not matter to me at all. I haven’t used the meter remote option in ages, so not being able to use it with the Vibe made zero difference to me. Your preferences will vary, of course.

WearabilityFor better or for worse, this pump does not feel different on my body because it is essentially the same physical pump shape/size on my body.  Having worn the Ping now since switching to Animas, the Vibe feels the same.  But, for the record, I did try a blue pump this time instead of my time worn silver one, which feels sassy.  Also, not needing to carry the Dexcom receiver makes for a lighter purse.  (And when my purse holds glucose tabs, my meter, an insulin pen, car keys, wallet, gum, Batman, and a deck of Crazy Mates on an average day, one less thing is awesome.)

Battery Concerns.  Since it’s only been a few days, I don’t know how quickly running the CGM and the insulin pump will burn through the battery.  As it stands now, my Ping went through about one battery per month (maybe every 5 weeks), and my concern is that the Vibe will require more battery change outs.  Time, again, will tell.

Software Questions.  I haven’t uploaded my data to Diasend yet, but I’m excited to see what the overlap looks like for my pump, CGM, and blood sugar data.  My past experiences with Diasend have been good – I like the software – but I’m not the best at uploading data from my pump (read:  I never, ever do it because the process is annoying).  I’m hoping that future iterations of the upload process make it more plug-and-play instead of “hey, weird dongle.”

Overall, I’m excited about the Vibe.  (And even if you aren’t, let me be excited, would you please?  I’m appreciating the fact that this system has finally been approved in the US.)  I like carrying one less device while still using the CGM and pump combination that I trust and prefer (bias, bias, remember). 

I’m looking forward to sharing thoughts at the close of this trial period, and then moving forward with a Vibe of my own … even if the name of the product gives me a bit of a smirky smirk.

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