Skip to content

Posts tagged ‘insulin pump’

Airplane Site Changes: A Grost.

Earlier this week, I flew to San Diego to visit with the team at Tandem and brainstorm some plans for 2016.  It was a quick trip (managed to land right when that weird storm was picking up speed – made for a very exciting landing and also reinforced my hatred of flying), but a productive one.

On Tuesday morning, before leaving for the airport, I needed to change my pump site.  In the winter, my skin has a tendency to become scalier and more irritated than in the warmer months, so skin real estate is a real issue, and site rotation is important, yet it’s challenging to find a place that wasn’t already somewhat rotten.

Against my better judgement (and mostly because I was in a hurry), I made the mistake of inserting my infusion set onto the back of my hip.  Normally, this placement is awesome and totally out of the way, but that morning, I managed to stick the site exactly where my waistband was situated.  It was also exactly where I would put my hands when pulling my pants on or off, making it a high traffic site.  But whatever – I was in a hurry, the skin was good there, and I’d just be really, really careful when sitting / visiting the ladies room / getting dressed.

I made it about six hours before I ripped the site off completely.

This moment happened at the end of my five hour flight home from San Diego, as the plane was starting to land.  Thanks to a paranoia about blot clots (hat tip to that pesky Factor V Leiden bastard), I drink a lot of water on long flights and get up from my seat very often.  (Apologies to anyone who has ever sat next to me on a plane.)  I wanted to duck into the bathroom very quickly before the plane landed, and in my haste, ripped the pump site out with swift precision.

Blood streamed down the side of my hip. Not optimal.  In a panic, I looked at the bathroom walls and door to make sure my grossness was contained, and thankfully it was, except now I had bloody paper towels and the plane was descending quickly and fuck I needed a new site in a hurry.  After cleaning myself off (stuffing the bloody paper towels into my pocket because I didn’t want to throw them in the garbage), I went back to my seat and said a silent thank you to my always-over packed carry-on.  A large Ziploc plastic bag that carried snacks and glucose tabs was emptied out and became the medical waste bag.  As the flight attendants were preparing the cabin for landing, I grabbed my extra infusion set and stuck it into my stomach without anyone noticing.  A quick fill of the cannula and I was back in business.  My horrible paper towels and infusion set garbage were contained and concealed without issue.

THIS IS WHY I OVERPACK.  Every time.  I get some flack for keeping an infusion set in my purse all the time and for carrying insulin pens, too, because rarely, rarely is there an issue.  I could not have foreseen the need to change out my site at my seat on the plane (fuck you, Miss Manners), but when I ripped out my site, it was less jarring to discreetly change my site than to spend the next two hours driving home to Rhode Island from Boston without insulin.

The moral of this story?  Insulin is necessary on the ground and at 37,000 feet.  Be prepared when you travel.  And for crying out loud, bring back ups because Insets are only available in first class.

New Year, New Disclosure.

Disclosures are important, so I’m making a new one today, and my disclosure policy has been updated accordingly.  There are some big changes on deck for 2016, with the first one being a change in some of the companies I’m partnering with.  Which is why I’ve decided to end my contract with Animas, because it was time for a change.

I wore a Medtronic pump for seven years before switching to Animas, and I’ve worn my Animas pump for the last six years.  Both of these pumps are solid insulin delivery devices and worked great, and Animas has been wonderful to work with and for, and I’m forever grateful for their support over the last few years.  But change is necessary at times.

Over the last two years, I’ve had some non-diabetes health hurdles (everything is fine, promise) and those issues put a different lens onto how I viewed my diabetes.  I wanted frustrations with diabetes kept at an absolute minimum.  Sometimes that meant ditching all technologies for a few weeks in order to give my body some breathing room, and to give my mind the opportunity to focus on the basics of my diabetes.  (I did MDI a few times this year, for several weeks, and it was good to revisit that method of delivery.  I learned, and relearned, a lot.)  Sometimes that meant acknowledging that the features I needed and appreciated were allowed to change.

But ultimately, it meant that I needed to let myself move on to different technologies that better suited my diabetes needs these days, and to different opportunities that fit where I’d like to lend my voice.

So here’s the disclosure:  I have signed an agreement with Tandem Diabetes Care.  My new agreement with Tandem went into effect on January 1st, and includes compensation for consulting services, including speaking on Tandem’s behalf at diabetes-related events. When speaking on Tandem’s behalf at such events, my relationship with Tandem will be disclosed to the audience.  (They won’t be involved in everything I do this year, so I’ll make sure I disclose appropriately when they are.)  With my physician’s prescription, Tandem provided me with products at no charge, including a loaner Tandem insulin pump and the cartridges and infusion sets I need to use the pump. Tandem does not compensate me for content on Six Until Me.  All of the content on Six Until Me remains my own, per usual, so my apologies that things aren’t suddenly going to become All Professional.

I’m really looking forward to working with the team at Tandem, and continuing to draw inspiration from the diabetes community as a whole.

And getting back to blogging.

And finding where the cats hid all of Birdzone’s hair ties.

Traffic Jam.

Last week, I was up in Boston visiting with Ed Damiano to hear some updates on the bionic pancreas (now known as the iLet – more on that later meeting this week), and our meeting ended late in the afternoon.

Which means I climbed into my car to make the drive home on Route 93 south towards Rhode Island at 6 pm.

For anyone who lives in New England, you know this is a recipe for sitting in the car in maddening traffic for hours.  The drive in and out of Boston is abysmal and unforgiving.  Sitting in traffic for hours on end trying to get to one stupid exit only to have to sit in traffic again for another long while is a waste of time and makes me endlessly grateful for my short commute.

But dude … I was on an iLet high, excited after hearing about how this new technology might help keep me healthy while freeing up brain space previously assigned to diabetes management.  Unfortunately, after peeking at my Dexcom, I was also on a bit of a blood sugar high.

212 mg/dL with an arrow pointing straight up, to be more precise.

“Gosh darn it,” is what I would have said if Birdy was in the car with me.  I was already in traffic.  It was going to be a long, needing-to-pee-because-hyperglycemia.  Time to bolus.

Several boops and beeps later, the correction bolus was en route.

Except – OCCLUSION ALARM OMG

“Oh for pete’s sake,” is another thing I would have said if Birdy was in the car.

I looked at the pump.  I haven’t had an occlusion alarm in ages, so I wasn’t sure what would happen next.  After confirming that none of the insulin had been delivered, I tried it again.

OCCLUSION ALARM OMG STOP TRYING

Well okay then.  Time for Plan B.

Plan B is always an option because I am painfully prepared for all kinds of crap things to happen at the most crap of times.  (Except that one time.)  My family mocks me for my giant purse, but when someone needs a bandaid or an insulin set or a t-shirt or a 3 lb bag of coffee or a brick or a small (small) weasel, I am their go-to girl.

Which explains why the contents of my purse often paint me as some kind of drug lord, because I thankfully had a syringe in my meter bag and a back-up insulin pen in my purse, just for moments like these when I’m in Boston traffic and need to shoot up quickly.  I disconnected my pump, uncapped my pen, and took my correction bolus old school style.  Nineteen and a half hours (read: two) later, I was back in my diabetes supply closet safety zone, where I could swap for a new pump set up.

This is exactly why I carry an insulin pen with me at all times. Even when it seems like overkill.

Which also reminds me – I need to update my stash of small (small) weasels.

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. 

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!

 

Follow

Get every new post delivered to your Inbox

Join other followers