Off-Dex

I took a semi-unplanned week off from the dexcom.  Some travel, some strip issues (doc’s office called in one touch BASIC strips, I didn’t notice they were wrong until opening the box, now I have to battle the pharmacy to swap them out).

Of course, in the meantime, this blog was listed by the diabetes OC and diabetesblognetwork and some folks have been visiting! Hello folks!! 

I plan to re-connect tommorrow and will resume blogging about it then.  But I will say, I’ve missed having it on!  I’ve missed the ability to spot a high trend and nip it in the bud.  And I’ve missed the motivational aspect of the instant feedback.  Even though the numbers are not always accurate, the trending seems to be fairly on-target, and having it on was motivating me to count carbs better in order to avoid big spikes above the line. 

The real goal, I think, is to motivate myself to avoid those spikes, just for the sake of avoiding those spikes! 

Jinxed!

Raise your hand if you just knew that my post about straight lines would be followed with my first post about crazy numbers!

I woke up Saturday morning and promptly accidentally popped out my infusion set.  I was not at home, and was ill prepared, so it took 45 minutes to get a new set in.  During that time, I watched my blood sugar’s steady climb from the 130’s to the 230’s. Once I was reconnected, I turned the corner and dropped back down below my ‘high’ line.

Unfortunately, I either over-corrected or I misjudged my lunch (a bowl of Frosted Mini Wheats), as I dropped into the 50’s (warned by both my body and my DexCom.)  Overtreated that and scooted back up.  Get the picture? 

Today was day 5 of my first sensor, and it was starting to bother me.  I also started to see just a few odd readings, so I decided to insert a new sensor.  No problems with the insertion, and I’m back to solid readings and a pain-free site.  Now, all that’s left is to manage my weekend eating and hopefully return to a more even keel.

Is that *my* blood sugar?

So far the most shocking aspect of this CGMS adventure is the fact that I keep seeing straight lines.  For too long (much too long), I’ve blown off diabetes care because I fully expect to see a lousy number when I check.  More times than I care to count, I’ve deferred or skipped a blood sugar check for just that reason.

 I was reading a post recently about what gets in the way of strong diabetes self management, and I definitely identified with the concept of vulnerability, as in “I’m doomed anyway, so it doesn’t matter what I do”.  I don’t spend a lot of time and energy on the doom and gloom approach as it applies to the long term, but I certainly see glimpses of it in the short term.  It’s not so much that I think I’m doomed as I’m pretty darn confident the next blood sugar will suck, so why check?

So I’m flat out surprised at how well my blood sugar has stayed ‘between the lines’ this past week.  Yes, I’m enjoying the perks of new technology: a rejuvenated focus on checking blood sugars, looking up carb values, and walking past the crap junk food at the supermarket.

But I’m also enjoying the fact that, for the moment, when I do what I’m supposed to do, I’m rewarded with ‘good’ blood sugars.  I know that’s not always the case, and that sometimes (often?) diabetes does not respond to vigilance. 

The next challenge – the real challenge – is to ease into a more comfortable balance between strict diabetes management and eating something more interesting than Lean Cuisine (which I enjoy not so much for its taste but for its perfect portions and nutritional information.)

A Full Day

Wow.

Wow, wow, wow.

I’m really trying to contain my enthusiasm for this, knowing that I’ve only used it for a day, and things can change.  And, really, it can’t always be this easy, right?

Maybe it can!

Yesterday was my first full day wearing the sensor.  I have to say, I’m pretty amazed.  I’ve had no ‘noise’ since day 1, and no problems to report to my trainer (who has called to check in twice).

My overnight blood sugars have been a straight line, which tells me that the recent basal adjustment made by my endocrinologist (after she saw the data from a 3-day CGMS study I did in December) was spot-on.  Now, instead of going to bed with a decent blood sugar and jumping up way high around 3AM, I maintain my pre-bed blood sugar throughout the night.

I have dropped my bedtime snacking, though, as I believe that may be a big part of my morning highs.  That will be an area for experimentation at some point soon.

I’ve also noticed a steady climb in blood sugars when I wake up at about 7:30.  My basal rate drops down at 7:00 AM, so I may need to tinker with that.  It’s just amazing to see the trends as they happen.  My inner science geek is definately enjoying all this data!

My focus right now is on basals and corrections.  So far, I’ve limited myself to foods for which I have the exact carb count available.  This has made for some boring eating, but until I nail down the basics I think it’s the best approach.  That overnight data,  that lovely straight line, is so nice to see but (since not eating is not an option) I have to figure out how to manage blood sugars and food!

Day 3: Lovin’ it.  Plotting ways to earn the extra $35 I need for each sensor!

So What’s Involved?

For anyone that might stumble upon this blog while searching for DexCom or CGMS info, I thought I’d take a stab at explaining the mechanics of my new STS.

The STS consists of three pieces.  First, there is the sensor, which is inserted into the abdomen using an insertion device.  My first insertion was basically a pinch, nearly painless.  The sensor is basically a plastic oval shaped disk that holds a very thin, short wire.  Each sensor is FDA approved for three days of use, but I’ve heard from many folks that the three day limit can be exceeded (and DexCom is currently pursuing 7-day sensor approval).

Snapped on top of the sensor is the transmitter.  This is one of the things that I liked better about the Dexcom (compared to the Paradigm).  It’s an inch long black plastic piece with no wires.  The parts that go on your body are relatively small and unobtrusive.

The third piece is the receiver.  It’s an oval shaped unit, 2″ tall and 4″ wide.  It comes with a case and belt clip so that you can keep it close.  In order to receive blood sugar data, it must be within 5 feet of the transmitter.  I’ve never comfortably worn my pump on a belt or clipped to my pants, so having the receiver attached to my waistband is taking some getting used to.  The receiver has to be charged every 3 days or so.  It can be charged while in use. 

The unit has to be calibrated with a finger stick blood sugar every 12 hours.  You can calibrate early and the 12 hour countdown gets re-set, however, which helps you avoid the need to calibrate at odd hours like 5AM.

Calibrating is a little cumbersome, requiring a specific meter (One Touch Ultra) and a cable.  The unit seems ready made for manual entry of blood sugars, but apparently the FDA wasn’t too keen on that approach.  Sticking to one meter (and a basic one at that) was necessary to keep the size and cost of the receiver down, according to my trainer.  The cable fits nicely in the back pocket of the meter case, but that of course makes the meter case a little bulkier.   Like anything with diabetes, I think it’s just a matter of getting into a habit (in this case, the habit of taking an extra minute twice a day to link the meter and receiver).

When you connect the receiver to a meter, it uploads all of your recent fingersticks and uses the most recent to calibrate.  The advantage here is that when the unit is downloaded, you have all of your fingerstick and dexcom data in one place.

The receiver displays your most recent blood sugar and a graph that shows your blood sugar over the last hour (you can also view the last 3 and 9 hours). The graph has room for blood sugars from 40 to 400, and also displays a line indicating your low alarm threshhold (mine is set to 70) and your high alarm threshhold (I’m at 240).  When your blood sugar… or rather the sensor’s take on your blood sugar… crosses that line, a beep sounds and a message displays.  If you don’t acknowledge the message, the unit pesters you with sound and vibration until you do.

So that’s the run down on the DexCom STS.  I’ll try to post some of my own pictures soon!

Connected

I sucessfully met with the DexCom trainer at my endo’s office this morning. I was quite relieved when she walked in, after last week’s false start.  The training was very straightforward and within about 30 minutes I was on my way, sensor inserted, awaiting the end of the ‘warm up’ period and the beginning of actual data.

Lunchtime arrived during that two hour warm up gap, and I found myself actually looking up the carb value of my Wawa hoagie.  I’ve had diabetes long enough to realize that the honeymoon phase of a new gadget should be milked for all it’s worth!  So rather than taking my usual lazy approach to lunch, I paused for the extra 60 seconds it took to look up the carb count.  As a result, my first hour of data showed a strong and steady blood glucose value of 165 mg/dl, give or take 5.

Within an hour, I experienced my first bout with ‘noise’, a graphic demonstration of why you don’t panic at the first out of range number.  I jumped up to 261 for a few readings, then settled back down to ‘real’ data.

I’ve set my high blood glucose alarm at 260 for now, in part because I don’t want to whip my diabetes in to shape too quickly.  Sound odd? Maybe, but I want to ease my body back in range.

DexCom day 1: I love it.  I love new technology, it’s painless to wear and nearly painless to insert.  The prospect of actually seeing a high number (that I could previously ignore by not testing, or by testing around it) was enough to motivate me toward better lunch choices.  All in all, a good start!

Meanwhile, back at my diabetes…

I finally got the nerve to have an A1c drawn yesterday.  My endo called this morning to report that my A1c is the highest it’s been since my diagnosis.  I knew it was high but man oh man was I disappointed.

I find that it puts me in an odd place about starting CGMS.  I’m really trying to restrain myself, to not get sucked into believing that CGMS will be the answer.  I know that there isn’t a technology out there that will compensate for the fact that I fail to look up carb values, or to accurately estimate portions, or to even really work to control portions.  No meter attached to me will address the fact that I’m not exercising, or that I think to myself, “I should check my blood sugar…” but don’t actually get to the meter for hours after (if at all).

 The fact is, I am in a big old diabetes rut.  And it’s time to get myself out of it. 

Having a different view of my blood sugar will help.  A new ‘toy’ always helps motivate me when it comes to diabetes management.  Though staring CGMS will not be the cure to what ails me, I am excited about it, and it is never a bad idea to be excited about diabetes.

I’ve rescheduled training with the DexCom folks for early next week.  In the meantime, I need to focus on using the tools I actually have at hand!

Follow the Instructions, to the letter

With my Dexcom unit, I received a checklist of pre-training steps.  The last step was to call the trainer and confirm our training appointment.

I had the appointment in writing already, via email, so I skipped that step.  Bad move, as said trainer did not show up at my endo’s office today!

I am disappointed, to say the least.  Even more so when he called to say that he didn’t show up because he hadn’t heard back from me.  I assumed that an email from him stating, “I’ll be there!” was confirmation enough.  Now I’m tasked with rescheduling, which I will hopefully do tomorrow for next week or the week after.  In the meantime, the $550 starter kit sits in my kitchen, taunting me.

Stay tuned…

In the Beginning

A dexcom sale rep described CGMS to me as follows:

Imagine that you’re driving a car with a covered windshield.  Every few hours, the cover is lifted, allowing you a glimpse of where you are.  This is traditional blood sugar testing.

Now imagine that you are driving a car with a clear windshield.  You can see the bumps, curves in the road, and other obstacles as they approach, giving you more of an opportunity to avoid them.

It’s not perfect, CGMS, but I’m looking forward to a bigger view of my diabetes.  Even if it means moving one step closer to actually being a robot.

Tomorrow, I meet with my endo and dexcom trainer.  Stay tuned!