Worst sensor so far

Sometimes my CGM is off by a few mg/dL and sometimes it is off by a lot more. It makes me feel guilty to see the large number on the CGM. Then I check my BG and see the reality....

CGM sensor wounds

The last time I put in a new Enlite sensor, it hurt quite a bit. When I pulled out the stylette (the needle part of the apparatus) I noticed it was bleeding quite a bit. I did my usual 360 sweep of IV Prep (the sticky swab) and when I went under the adhesive that sits under where the transmitter would sit I even got blood on the swab. I applied gentle pressure for a few minutes and (because previously, in error, I have attached the transmitter too early and had huge discrepancies, which eventually led to "bad sensor" and "change sensor" alerts) I did not attach the transmitter for a good 2 hours or so.

Overall this may have been one of the more accurate sensors I have used. Maybe because it was getting some blood readings in addition to interstitial fluid, or maybe just luck. Anyway, I pulled it out by accident on day 4 and realized that the adhesive does not stick as securely when there is any blood on it!

Check out the great bruise I have. If you look closely you might see the outline from the transmitter in red irritation lines too..

So today I went to put in a new sensor and decided I would be as gentle as I could (Maybe I had bled the last time from pursuing to hard?) So I just placed the loaded inserter on my skin without applying any pressure, except to keep the insertion device flush against the surface of my skin. Very little pain (except for the force of the insertion device; that thing is quite forceful and leaves a slight stinging sensation) so I thought I had had success. However,  I don't recommend anyone try this light and gentle technique! When I removed the device, I had some of the adhesive around the electrode+needle sticking and no needle or electrode in my skin! I wish I had got a photo but instead I panicked and pushed the electrode+needle into my skin. I think I was successful at getting it in since the transmitter did flash upon connection. But who knows? I just hope I don't have to pay too much in the next couple months on sensors since most insurance companies won't pay for more than 1 every 6 days. I've already pulled out 2 (by mistake) around day 4 or 5. I guess I should use up the leftover sof-sensors (the previous Medtronic model, for those who don't know) I have "hoarded" before they expire in May! I would really rather not. There was a lot more bleeding when I used those inch long buggers!

Take care not to bruise yourselves like I did!

New pump and CGM! :D

Just in time for 2014, I got the new 530G Medtronic pump and Enlite sensor (for continuous glucose monitoring). It is always fun to get new things and see all the new features available on such a piece of technology. Unfortunately, now that I have the pump and I've done all the reading and training to use it, I don't know if I will actually be able to use all of the new features. So what do I have? A fancy, upgraded (*and purple!) version of what I had before. Don't get me wrong. As a tool for my diabetes and getting closer to my A1c (average glucose) goals this should be beneficial and I'm glad I got it. I'm just not as excited to have it as I was anticipating receiving it. It is supposed to be more accurate and at least I don't need to pull out the user manual and I can clear an alarm without looking, but I feel like that is part of what makes new things fun.
In contrast, I got a FitBit for Christmas and I am constantly looking up tips and hints on their Help site! The new pump just went in my TummieTote (which is my favorite pump accessory by far!) and I more or less forgot about it. Not one part of the dimensions, buttons or general appearance has changed.

Let's break down the good, bad and things I'm indifferent about.
 Pros:

• I can dial in basal rates and boluses in much smaller amounts with up to 3 decimal places (which I might not necessarily need, but my doctor wants me to try).
• I can flag events under "Capture Event" such as exercise, food (without bolus), and meter BG (without bolus or calibration) so it will show on the pump software reports my doctor sees instead of having to match up a separate record. That is, as long as I remember to "Capture" at the time the event is occurring. (If only it had NFC capabilities...)
• Threshold Suspend - this is the most hyped feature of this pump, which Medtronic chose to title an "Artificial Pancreas" feature. When turned on, the pump will suspend all insulin delivery for 2 hours if I do not respond to a Low Glucose Alert. This is only beneficial if the CGM is accurately calibrated, i.e. I truly have low blood sugar when the sensor indicates. Also this will have a loud, obnoxious, continual alarm during the entire time the pump is suspended. If I am unconscious then hopefully this will mean that someone (probably my husband or a coworker) will come to my aid. When not properly calibrated (which could happen in random situations), this could mean a lot of disturbed sleep.
• Overall accuracy of the sensor should be improved.
• Size of sensor electrode is smaller in length and gauge. It is much less painful on insertion too. I was shocked by how little I felt (I inserted my first Enlite sensor on Jan 7, 2014 at a pump training session so will be doing my second insertion by myself, probably tomorrow!). I also don't have to pinch or look for fattier areas to insert the sensor or worry about significant bleeding which I think will improve accuracy. I can put it in less fatty areas with less scar tissue and better circulation (of glucose to interstitial fluid from the bloodstream and vice versa). Hopefully insertion will continue to be easy, since I have read reviews saying otherwise.
• Sensor has been approved (and will continue to work without the 3 hour restart period) for use for 6 days. Since I used the old sensors for as long as possible (despite them only being approved for 3 days) and on average got about 8 or 9 days out of them, this is not exceptional for me. With the minimal taping advised and my fear that the sensor will pop out, especially with summer activities, I really hope the majority of sensors last for 6 days.

Day 2 (Jan 8, 2014)

Day 5 (Jan 12, 2014) Surprised the sensor is still in

Day 5 (Jan 12, 2014) There is no way to replace this wider tape, and it is all I can use to hold the sensor half of the CGM down. Water freely flows under parts of it (what will happen if I go swimming?) and last night my pump tubing got caught under the transmitter side (which hurt!).

 Good things (Beneficial, but not fantastic):

• The reservoirs, infusion sets and overall set up, buttons to press, etc are the same.
• Menu is much more user-friendly. It uses titles like "Reservoir + Set" and "Fill Cannula" instead of the more general term "Prime". Once an Alarm is cleared, the pump displays the part of a menu that would come in use for that alarm.
• Low and high prediction Alert.
• Trending high or low Alert. This would be extremely irritating if there is no significance to the increase. For instance, if I increase from 130 to 100 over 10 minutes, it doesn't matter to me as much as a situation where I go from 100 to 70 in 10 minutes. However this feature does not discriminate between the two situations.
• Missed bolus reminder for those who forget to bolus during a certain time period. This is useful but it requires a person to eat at the same times each day. I love the flexibility of having a pump because I tend to have a different schedule on any given day. I will soon get "alarm insensitivity" if I used features like this. It would also be a hindrance if I am speaking with a client at work and my pump keeps vibrating. I also hate having to explain these sorts of things to strangers.

 Cons (mostly my concerns):

• When I have the option for Low Alerts turned on, I also have to have the High Alerts turned on. It might not be intuitive, but I don't really mind having high glucose. I usually test my glucose every 5 or 6 hours or look at the number on my pump. At minimum I test before each meal and/or snack. If I have high glucose, my basal rate will take care of it or I will catch it in plenty of time to compensate. Luckily, I can set the high alert to alarm every 3 hours instead of every 20 to 30 minutes as I usually set the Low Alert. Low glucose, especially when I am having a "good BG day" is much more important to catch asap.
• The instructions in this pdf document are the only backup I have for preventing moisture (sweat, shower, pool water, etc) from getting under the adhesive holding the sensor in place. I do not feel confident about this staying in place during a day at the waterpark or just a day outside in humidity of a Virginia summer. My pump trainer said that if we use the entire IV3000 transparent dressing over the sensor and transmitter together (which I found worked the majority of the time with the old sensors) it will buckle and cause the sensor electrode to pop out. This is unfortunate because she also claimed that most insurance will not cover extra sensors. Meaning: I'm probably going to be wearing the sensors for more than 6 days to compensate for those I might lose. I'd say that I would minimize the number of showers per week or the amount of activity I do in my pool or outdoors during the summer, but that's not going to happen!
• This pump only works in mg/dL and my brain works in mmol/L. I didn't even ask about that because my old pump had both units (apparently people are bad at selecting units and picked the wrong one and messed everything up...argh...FDA..). So after nearly 25 years (in March 2014) of using mmol/L from living in Canada, I have to adapt to new units. And after probably 15 years of One Touch meters, it looks like I'm going to be switching to Contour (since the Contour Next syncs with the pump, which is pretty cool). I have already made the mistake of overcompensating insulin correction instead of letting the Bolus Wizard take care of it.

 To anyone considering upgrading: if insurance will cover it, I highly recommend doing it. I don't know how this pump will be for me over the next 4 years, but I figure the more up-to-date I can be, and call me crazy, the closer I will be to having the correct calibrations and preparations for the true Artificial Pancreas that is on the horizon!

Most recently: HbA1c: 7.4%, 140.5 lbs; left ankle mild peroneal and Achilles tendinitis, calf cramping. Have not worked for 5 weeks and doing physical therapy twice a week. Exercise: stationary bike, stretches. Calorie counting with FitBit.

Beginning the balancing act: my diabetes goals

I have had Type 1 diabetes for almost a quarter century. During this time I have tried, mostly unsuccessfully, to maintain tight blood sugar control. I have reached a point where I want to be successful at this balancing act or I will suffer some life-threatening consequences.

I recently spent several weeks recumbent and incapable of working or getting around on my own recovering from foot surgery. It gave me time to enjoy life and the things around me and forced me to realize that working is not all there is to life. I realized years ago that we spend more time at work (or school) and sleeping than we do with loved ones and enjoying our hobbies and interests. I wouldn't call it my "biological clock" but something similar told me it is time to think about bigger things: my legacy.  My husband and I have decided we would like to start a family. We would prefer to do so by traditional methods, and it is going to take a lot of effort on my part.

I hope I can help others, and get advice from those who have been through it, by keeping a log of my endeavors.


Most recently: HbA1c: 7.9%, 146 lbs; left ankle pain, mild plantar fasciitis 

Goal 1

Decrease HbA1c to 6.0 or below

Goal 2

lose 20 lbs

Goal 3

minimize highs and lows

Goal 4

get the ok from my endocrinologist!