A Bad Habit.

When my endocrinologist downloads the data from my Dexcom receiver later today during my appointment, she's bound to notice quite a few gaps - like the one last night, where there will be no data from around 11:30 pm until I woke up this morning at 5:45 am.

You see, about a half hour before that I had clocked in at 80 mg/dL. I had no insulin on board and no food in my stomach, as dinner was hours before that. I hadn't gotten much exercise that day or the day before, so I felt reasonably comfortable taking the gamble of doing nothing about a reading that teetered right on the cusp of being "low".

The gamble of being 80 mg/dL at bedtime and not treating or temp basal ing or anything. #fingerscrossed #lowBGiscontextual
— Kim / Diabetes (@txtngmypancreas) June 17, 2014

Literally the only things I did in the next few minutes were brush my teeth, plug in my phone, and lay down. I tossed and turned though, and couldn't find a comfy position. And when I finally did?

BZZZ! BZZZ! BZZZ!

Where the hell did that 67 come from? And then the 55? Mild sleepiness transitions to anger: Ugh, GOD, I'm fine, stop freaking out.

Again: BZZZ BZZZ BZZZ BZZZ!

That's it; I'm done. You're done. 

Some might say, "TURN DOWN FOR WHAT". Lately, I too often say, "SHUTDOWN FOR SLEEP".




#AllTheSocialMediaChannels

It worked out in this instance, but there's never any guarantee - when I turn off my CGM receiver, I'm opting out of a safety net. In theory this shouldn't bother me, as I should be able to use technology in the ways it works for me (and opt out of it when it doesn't), but that all too often comes with a side order of guilt. When I'm forced to decide, "what's more important - sleep or safety?", all too often the need to sleep has been winning.

Joslin Diabetes, Dexcom, and "The Institute".

I just got this email (bold emphasis is mine):

BOSTON (June 10, 2014) – Joslin Diabetes Center today announced the introduction of the Joslin Institute for Technology Translation (the “Institute” or JITT), a new division of Joslin Diabetes Center that formalizes the delivery of Joslin’s clinical solutions to medical device and technology companies. In addition, it was announced that Dexcom, Inc., a San Diego-based maker of continuous glucose monitoring systems for patients and blood glucose monitoring systems for healthcare providers in hospital settings, has joined to become the first Founding Member of the JITT and is a member of the Institute’s Advisory Board. 

“Our goal in establishing the Joslin Institute for Technology Translation is to further the use and development of technology and medical devices to improve diabetes care, improve the lives of those living with diabetes and reduce health care costs,” said John L. Brooks III, President and CEO of Joslin Diabetes Center. “With Joslin’s expertise as the world's largest diabetes research and clinical care organization, the Institute is uniquely positioned to impact digital health by offering meaningful solutions to strengthen technology, and we are extremely pleased to have an organization of Dexcom’s caliber join us in this quest.” 

The mission of the Joslin Institute for Technology Translation will focus on four key areas: 

· Create and offer physician-designed, and patient-tested, decision support tools for improved solutions in glucose and insulin management;
· Be a powerful voice in moving digital health to improve diabetes care in a cost-effective approach – collaborating with numerous medical device and technology organizations;
· Create individualized, confidential collaborations with industry partners providing new solutions that advances the monitoring and treatment of diabetes via new technologies; and
· Pioneer innovative education and training programs that optimize decision-making processes and the adoption of best-in-class technologies for healthcare professionals and patients world-wide.

Mountains of jargon aside, this sounds like something to get excited about. Full press release found here.

Anatomy of a Dexcom Graph.

At first glance this graph looks... not fun, but something along the lines of "you were running high, did a correction bolus, and then you were low".

But looking at it another way, it's:

1. "Why is this high so sticky? I under-bolused for that sandwich at lunch because I could see I was dropping and knew I'd be home alone with my daughter for the next few hours, but apparently I overdid it. UGH. This feels so gross, and it's almost dinner time. Since all of those corrections over the past few hours didn't do much, I'm finding out what my pump would suggest for a correction bolus if I had no IOB and bolusing that amount."

2. "Yaaaaasss. Now stick the landing, you glucosey blood you."

3. "No no no noooooo [insert curse words here] do not want, stop it. Just level off! Stop dropping! You're good! Just stay right here!"

4. {inhales Peeps; notices legs are tingly/numb; delegates remainder of dinner assembly to husband; sits at dinner table waiting to regain self}

I find myself doing this thing where I underbolus for food or just run a little higher in general when I'm with my kid because I don't want to drop low while I'm the only one responsible for her, but I usually end up rage-bolusing my way out of it and end up low anyway, the very outcome I was trying to avoid in the first place.

Wow, so doge meme, how obsess, much annoy husband, very giggle!

Dexcom.

I have been wearing some version of a Dexcom continuous glucose monitor (CGM) since 2010. Last October I received an email from someone with a "@dexcom.com" email address who asked if I'd be interested/willing to be featured on Dexcom's website.

Um...

::cough:: Pull yourself together, Vlasnik! Play it cool! I mean, yes, those terms would be agreeable.

Several months went by, but I can now say that as of today and until they realize this was a really bad idea, you'll find me listed in the "Heroes" (awkward!) (update: warriors?) section of Dexcom's website. I very much appreciate their willingness to share some patient stories there, which hopefully connect more of us with each other as a side effect.

It should come as no surprise to anyone who has read this blog over the past few years that I am a big fan of CGM technology. Aside from insulin, it's the most valuable tool I have in my arsenal. I wish more people had access to them.

Stuff like this can justifiably raise some eyebrows, so allow me to be clear about what this means (and what it doesn't) disclosure-wise. A short Q&A:

So does this mean you're getting free sensors now? Are they sponsoring you?

No, but it did mean that Dexcom sent me one box of G4 sensors one time at no charge. This is not on-going thing; my insurance and I will still be buying my sensors moving forward. 

Does this mean you are endorsing Dexcom now? 

Not in a "paid spokesperson" sort of way, no. I remain a paying customer of theirs and am under no obligation to write or otherwise share about my experiences in using their products. This feature was Dexcom's idea and they were the ones who did the approaching. They have no editorial influence on this blog or any other social media endeavor of mine. You'll still find me relating my graph shapes to animals, venting about error messages and accuracy issues, and celebr-tweeting when my 3-hour trend is a flat line. Good and bad, always. 

But kind of "yes"? 

That said, the release I signed does indicate that certain images and/or the words included in the "Heroes" feature can be used by Dexcom in any future promotions and at their discretion, so for all I know I could be Photoshopped next to a CGM-wearing, unicycle-riding squirrel* next week. C'est la vie!

If you have any questions or concerns I'd be happy to address them. In the meantime, here's where you can find the feature.

*Dexcom products are not approved by the U.S. Food and Drug Administration for use by squirrels, just so we're clear.

Dexcom Handle.

One disadvantage of sporting an arm site for my Dexcom sensor:

They're within reach of tiny hands and tend to be grabbed onto any time a "handle" is needed. (And those tiny hands tend to release their grip seconds before you're able to snap a photo, but I trust you can use your imagination.)

CGM: Must-Have.

Reason #3752 that a continuous glucose monitor is in the "must-have" category when it comes to my health:

Fasting numbers don't reveal the whole picture. (Hellooooooo, adjusted basal rates. Would I have even known you needed to be adjusted, if not for these graphs?)

Steampunk: Diabetes Style.

Someone (@momentsfade) on Twitter tore apart a dead Dexcom transmitter and tweeted photos of each stage of the deconstruction, which lead to the comment:

@momentsfade @SweeterCherise @txtngmypancreas @joltdude It's not steampunk enough for me ;-)
— Kelly / Diabetes (@KellyRawlings) January 14, 2014

One tweet, and my mind goes off the rails:

Dexcom G4 Platinum: What I Like (and What I Don't).

A baby and 14 months later, I finally can check "do a follow-up YouTube video on how I like my Dexcom G4 Platinum" off of my to-do list. Remember that unboxing one?

I realize none of this is earth-shattering news, but hey, you know, might as well provide some unsolicited user experience feedback. Mostly I did this so I can stop thinking to myself, "I really should get around to that..."


 

(I should also note that this video assumes you already know the basic "pros" like, "It tells me trend information!" and "It alarms for high and low BG parameters that I can set!", and "cons" like, "I have to wear a medical device!" and "Holy hell this thing is expensive!".)

Choosing An Insulin Pump, Continued.

[Find the first post here.]

Wheels have been turning! Here's where things stand.

After checking with my insurance carrier, I got the first-round standard answer that the pumps they're willing to cover amount to the four "more established" brands: Animas, Medtronic, Insulet (Omnipod) and Accu-chek.

But, in talking with the remaining two companies (Tandem and Asante), those options could potentially be back on the table coverage-wise. Paperwork has been submitted for both (solely for insurance verification purposes) because I'd like to know if my choices are less limited than that since I don't have $6,000-ish just laying around to buy a pump at full retail cost. Like just about everyone else with diabetes, my options are limited to what my insurance carrier decides. (And luckily for us PWDs, those device manufacturers are willing to do most of the heavy lifting with insurance companies to ensure coverage - less work for me!)

That said, I'm fairly sure that I've narrowed my decision (insurance coverage pending) to three: Ping, t:slim, or Snap.

I've been in the fortunate position where some of these companies have reached out to me to see how they could help me decide, and as a result I'll be trying some stuff out. I've already met with my local Tandem rep (Hi Nathan!) to ask more questions and experience the t:slim up close again, and I'm looking into seeing Medtronic's new "530G with Enlite" LGS system (notice how I'm NOT calling it an "artificial pancreas"?) in person. I'm waiting to hear back from my endo, but things should be in place to do a short trial with the Snap pump, as well. (And I'm definitely planning to share my experiences with the Snap, as soon as I can get my mitts on one.)

And speaking of devices - I hadn't realized that I was already out of warranty with my Dexcom system, but that's all straightened out now and I have my new system (black receiver this time!) sitting in the living room, waiting to be unboxed.

To add to the chaos, I'm also seriously considering a switch to Verio meters over my well-loved iBGStar. More on that later.

Apparently I like to overhaul all of my diabetes gear at the same time.

Go big or go home, or something.

Twinsies.

That's an impressive little algorithm you've got there, Dexcom.

Week Twenty-Four.

Remember four weeks ago when I said I was "in the tail-end of that 'is she or isn't she?' phase of roundess? 

My bump, my bump, my bump, my bump. My lovely baby bump. Check it out!

Duuuuude, she is. I've reached a point where people have asked those around me to confirm, and co-workers are offering to lift heavy things for me. Strangers are smiling, holding more doors open and I may soon break out with an "I'm up here, buddy" as I catch people eyeing my belly.

I'm fairly certain that insulin resistance is starting to take hold now. (Cue sad face.) There are times I have a handle on things (top left image, right before the chaos, anyway), but then a few carbs/the wind/looking at a cracker will just send me to the moon. Onward, basal rates and other adjustments!

I mentioned on Monday that my Dexcom receiver busted ("busted" meaning that the button ring fell out), and it took me until yesterday to actually get around to calling Dexcom. Normally that would be okay, but I sort of forgot that I'm leaving town on Sunday (more on that in a minute) and forgot that I'd need the new receiver before then. The gal I spoke to at Dexcom was helpful, and offered that since the black receivers were currently backordered by a day - and thus, one wouldn't arrive until Monday - she could send me a different color. I don't know why I got pink; I think I must have blacked out for a second. But in the end, the hue of my receiver is far less important than having a receiver at all, so I'm delighted that I won't have to travel with a busted medical device.

I'm fairly enamored with the baby legs tutorials I've found on Pinterest, and had a go at making a pair a few days ago. My sewing machine also decided to bust right after that, though I can't confirm whether the two events are related. Right now I have a bunch of cut-up socks laying around and it's driving me crazy that I can't finish them.

Okay, and then to circle-back to the travel comment: from Sunday through Tuesday, my footlong sub* and I will be traveling to Indianapolis for Lilly Diabetes' third second annual Blogger Summit. (Disclosure: Lilly Diabetes is covering the expenses of my travel, lodging, and meals during the summit.)  I hope that our DOC group will be able to walk away from this event thinking, "yeah, we actually got a list of actionable items to work on together in the coming year, and I feel my time here was productive for the diabetes community as a whole". We've been told there will be more info given on the Lilly/Disney partnership, as well as a tour of an insulin manufacturing facility and a meeting with some of Lilly Diabetes' leadership team.

If you have something you feel we should bring up to Lilly while we're there - please leave it in the comments below, and I'll do my best!

*One of this week's pregnancy tracking email updates likened the current estimated size of Baby Girl to a footlong sub, which I found particularly cruel as cold cut subs are on the "hell to the no" food list and now all I want is a darn turkey and cheese sandwich.

Falling To Pieces?

Guess who I'll be calling today? (Luckily I was able to pop that disc back in and it is still taking readings, but the functionality is, as they say, "wonky".)

Clean Off.

It appears that I should really be more careful when approaching chairs with unforgiving arm rests....

While the Flexifix tape did its job of keeping my three day old Dexcom sensor's adhesive stuck to me, the actual sensor ripped almost clean off. Part of the wire might still be in my skin; I couldn't tell, but the wire looked shorter than normal to me after I removed it.

I guess we'll find out the next time I'm at the airport?

One Too Many And Eleven Short.

I just spent 39 minutes on the phone with Peyton, a member of Sanofi's iBGStar tech support team. What we determined (rather, what I unofficially deduced from our conversation) is that the iBGStar is not a fan of tequila. And neither is an 18 day-old Dexcom G4 Platinum sensor, for that matter.

Verio, my hero.

When I use the iBGStar meter, I typically keep it attached to my phone all day and use the case that encloses them both. I don't open the iBGStar app every time; actually, not even every day. When the app is opened, it automatically syncs the meter with your phone, and thereby downloads all of the readings it has recorded since the app was last opened.

After consuming a few margaritas and checking my BG eleven times throughout the course of yesterday evening (this is how I drink with diabetes - YDMV), I noticed that my last three readings were suggesting a pretty steep drop - and no thanks to my CGM, I couldn't verify this via visual aide - 356, 226, and then 184. Pleased that I was dropping but concerned with the velocity, I decided to open the app on my phone to help me remember the times of those tests. I had a need for speed (information).

Instead, I was informed that I would be on my own with this one.

Excuse me, what? I then clicked the (only) button on the meter, to see if I could scroll back on there to see the times there.

DENIED.

"Awesome".

What I realized, as did Peyton by the end of our lengthy phone conversation, is that there is no good reason my meter wasn't tagging date and time on those eleven readings. We tried everything to figure out why - close the app. Restart the app. Unplug the meter. Replug and sync the meter. Check the phone's time/date settings. Check the meter's time/date settings. Make sure the meter is fully charged (it was). Make sure the meter was fully plugged into the phone (it was). We must have gone through 30 different potential factors. (I also elected not to delete the app and re-download it. While I was able to back up the iBGStar data through my iTunes account, you can't actually look at it. Petyon told me that if I deleted and then downloaded the app again, I could reinstall the old data. I didn't want to muck around with it.)

We have no idea why, but the good-ish news is that it's recording those things again. I tested twice, voluntarily (he suggested I use control solution; I laughed) and both of those readings downloaded just fine, while continuing to ignore the previous 11. I could manually enter them, but seeing as how I don't know the times for most of those, I'm hesitant to do so.

Tidbits I learned:

1. it's recommended that you plug the meter into the wall, using the micro-USB cable provided, at very minimum once every six months - more frequently if you're a more frequent user. I asked him the logic behind this, seeing as how the meter is charging every time my phone is active, and he mentioned something about it being a more potent power source. I still don't get the reasoning - if it says 100% charge, is that a lie? - but okay, fine. I'll do it.
2. it's also recommended that when you first get your meter, you should charge it with the wall outlet cable for three to five hours. Again, I don't know why, but just do it.
3. Sanofi really wants you to be happy with this system, and will do things like send you more strips to replace the ones you used when the meter wasn't marking a time on them (they're sending me 20, which is lovely) or replace the meter if you feel it isn't working to your liking (I declined this time, but if it acts up again, yes please). I know that the test strips are where they make their money, and so a replacement meter really isn't that big of a deal, but it was still nice to find out.

I also was reminded that you always need a back-up for your back-up. CGM won't give you readings? Time for a fingerstick. Meter won't function properly? Use a different one. 

It's possible that everyone in your usual device line-up will fail you at the exact time you need them most. Channel your inner boy scout, and always be prepared.

Because I know some of you will like "closure", here is what
my graph looked like from midnight to noon.

Lessons Of Perseverance.

Nothing worthwhile comes easily. Work, continuous work and hard work, 

is the only way to accomplish results that last. 

- Hamilton Holt

(ONE OF MANY SIZES OF) SKINNY JEANS FINALLY FIT YOU GUYS.

Confidence comes not from always being right, but from not fearing to be wrong.

- Peter T. McIntyre

Nothing builds self-esteem and self-confidence like accomplishment.

- Thomas Carlyle

A life of rich fulfillment comes to those who are also thankful for the setbacks.

- Author Unknown

You need to be aware of what others are doing, applaud their efforts, acknowledge their successes, and encourage them in their pursuits. When we all help one another, everybody wins. 

- Jim Stovall

Why do we fall, sir? So that we might learn to pick ourselves up.

- Alfred Pennyworth

When the world says "Give up", hope whispers… "Try it one more time".

- Author Unknown

Like A G6... er... 4.

First of all, Happy Halloween!

The best I can say is that Billy tolerated this costume. It fits better than last year!

Secondly, my Dexcom G4 Platinum showed up yesterday. I want to tell you all about it, and sometimes it's just easier to show you:

One More.

I put in my last (?) Dexcom sensor two weeks ago. I did it a little ceremoniously, assuming that it would be the final one of the Seven Plus variety, as I had placed an order for the G4 after finding out that my insurance plan will cover the majority of the cost (a fact I'm very, very thankful for).

Last night, I got the following in my inbox:

Happy Snoopy Dancing aside, I think my sensor must have sensed the foreboding in the air as it got more and more wonky (technical term) as the day drug on. Wonky to the MAX. The kind of wonky that caused me to waaaaaay under-bolus for my nacho dinner. Evidence:

So much product placement!

Anytime you want to get here, G4, I'm welcoming you and your better accuracy-having self with wide open arms. I'm also wondering if I'll wearing both the Seven Plus and the G4 simultaneously for a while.

What's one more robot part among friends?

UPDATE: My G4 was originally scheduled to arrive Wednesday, but after checking the tracking ID, the G4 is on the delivery truck RIGHT NOW. (!!!!!)

Device Story.

If you follow people with diabetes on social media, it's likely you've noticed a flurry of excitement surrounding the new Dexcom G4 Platinum continuous glucose monitoring system. It's slimmer, it's more accurate, and it makes the Seven Plus system seem like the Tommy Lee Jones of this CGM family. Type 1 diabetes, especially, requires that we make hundreds of decisions and judgement calls each day about how to care for ourselves, and wearing a device like a CGM helps us make those decisions in a more informed way. If finger sticks can be considered still photographs, a continuous glucose monitor is our live-streamed video. It may still have some buffering issues, but some data is better than none.

I've watched this week's conversation arc of "I want this so bad!" to "On hold with Dexcom now" to "It's how much?", sometimes progress to "I'm approved! It ships in a few weeks!". (I called Dexcom on Monday morning and heard back Wednesday afternoon - pending my doctor's approval, all systems are GO.) With so many upgrading to the new system, I'm now wondering - what will we do with the old ones?

I mean, has anyone stopped to consider good ol' Seven's feelings about this? It seems like someone could write a whole new version of the Toy Story movies, with characters like Jessie swapped out for a Dexcom receiver. (So, Device Story?)

Once a precious and valued member in our collection of medical devices, Seven will be ousted by Platinum (Platty? Plato? I'm still working it out) and suddenly, he's no longer needed. He'll have to watch from a drawer, shelf, or cabinet as we discover, with wild fascination and anticipation, why our new "toy" is so much better. He'll collect dust. He'll think back on the "good ol' days" when he so proudly alerted you to the times you were under 80, and then 81, but hang on you're 78, scratch that you're 82, and now you're 75. He'll regret the times he became confused and couldn't tell you anything useful. He'll be happy for you and the joy your G4 brings you, but inside, he'll be so disappointed that your joy was found elsewhere.

Maybe my Seven needs a proper send-off to honor his service. Should I release doves? Recite a poem? Take it out once last time and buy it a shot of whiskey?

Or maybe I'll keep him on standby - just in case.


Andy: Oh no!
Andy's Mom: Andy? Let's go! Molly's already in her car seat!
Andy: But Mom, Woody's arm ripped!
Andy's Mom: Oh no! Well maybe we can fix him on the way.
Andy: Nah, just leave him.
Andy's Mom: I'm sorry, honey, but you know, toys don't last forever.

Want.

Dear Santa,

All I want for Christmas this year is a Dexcom G4 Platinum.

And maybe a gift card to Sephora.

But mostly the first thing.

Loooooooove yoooooou,

Kim

Just Not That Into You.

Hey there; it's me

Your CGM sensor of two weeks.

I see that you've noticed

My data-grabbing leaks.

How I'm speaking out of turn;

How I itch like mad.

How I can't even spit out

Most of your numbers - sad.

I was once so accurate;

So error-free.

You threw caution to the wind

And put your trust in me.

But now, my dear

It's time to part ways.

This dingy old sensor

Has lived out his days.

You're clinging to hope

It's yourself you're fooling.

I'm calling this game;

I'm issuing this ruling.

We had a good run

But now I'm afraid we're through

Because the truth, dear friend, is that

I'm just not that into you.