The Best (and Worst) Insulin Pump Infusion and CGM Sensor Sites

Like many other people with diabetes, I wear two devices on my body at all times: my insulin pump (my pod) and my continuous glucose monitor (CGM). And I’m often asked whether or not these little gadgets are painful.

Fortunately, the answer is that most of the time, they aren’t. I rarely feel it when my CGM sensor or my insulin pod’s cannula pierce my skin, which makes the whole experience of wearing them a lot more comfortable – and much less dreadful when it’s time to rotate sites.

Speaking of sites and pain, though, I admit that there are some sites that, for me, tend to work better than others. The following are the different locations I use for my pod and CGM sensors, in order of what tends to be best to the worst.

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My stomach is my preferred spot for my pod AND my sensor.

Stomach: This is the site at which I have the best insulin absorption, so it’s a clear winner for me when it comes to my pod placement. I also find that it almost never hurts when I press up against the pod (e.g., when I roll over in bed in the middle of the night) when it’s on my belly. The same is true for my CGM sensors, which also seem to be the most accurate when they’re placed on my abdomen. I guess there’s a reason why the stomach site is the only one recommended by the FDA for the Dexcom CGM (which is what I use)!

Lower back: I have yet to try my CGM here, but I often place my pod on my lower back without issue. This site can be trickier to navigate because if I forget that my pod’s there when I’m getting dressed in the morning, I can come precariously close to accidentally knocking it off – and I have in the past. Plus, the pod can rub up against me in an unpleasant way when I’m working out; specifically, doing any sort of abdominal exercise on the ground. But it’s not something I can’t tolerate, and the insulin absorption in this location is just too good in general for me to pass over it altogether.

Upper arm: I wear my pod and CGM on my upper arms sometimes, but they don’t always adhere well for some reason. Getting dressed can be even more problematic for me if I forget that my sites are on my arms – I’ve totally ripped off pods and sensors when I’ve been taking off and putting on clothing. And for a long time, my CGM sensors would make me bleed when I inserted them in my upper arm. I never figured out why, and the problem seems to have gone away, but it definitely made me a little more wary about using my arms as a site (PLUS any devices I wear on my arms are highly visible, and I don’t always like it when people stare at them).

Thigh: Hands-down, the worst site for my pods are my thighs. For starters, wearing denim jeans – especially if they’re skinny jeans – are such a feat when wearing a thigh pod. The fabric pushes up against the pod in such a way that I prefer wearing dresses, skirts, or leggings for the three days that I have a thigh pod just so I can be more comfortable. And speaking of comfort, it’s tough for me to get into a cozy sleeping position when I have a thigh pod because I like sleeping on my stomach sometimes, and there’s just too much pressure up against my pod when it’s on my thigh. And for me, it seems that insulin absorption just isn’t great on my thighs (maybe because they’re on the muscular side). BUT, I will say…I recently tried a CGM sensor on my thigh for the first time and I didn’t hate it! The accuracy was good and it wasn’t in the way as much as a thigh pod (I keep wanting to type “tide pod”) would be. I’ve only had it on my leg for a few days now so I don’t know yet how the adhesive will hold up, but I’ll find out.

Spots I haven’t tried yet (but want to): On social media, I’ve seen people wear Dexcom sensors on their forearms (eek), upper butt cheek (tee-hee), and even on their calves. And pod placement can get even wilder with spots in the center of the back (HOW can people reach back there) and, um, the upper-breast area (one word: ouch). While I don’t think I’ll ever work up the courage to try some of those spots, I am curious about others.

The bottom line is, though, that the sites that work best for me might not work as well for you. (The same thing can be said for my worst sites.) But it is important to remember, above all, the importance of rotating sites…even though I’m clearly not a huge fan of pods on my legs, I’ll still suck it up and place them there because I know that I should be careful of scar tissue buildup.

It just makes the pod-and-sensor-change days that much more pleasant when I can move them from a disliked site to a favorite site, anyways.

 

A Diabetes Stream of Consciousness

I first heard the term “stream of consciousness” when I was in high school. My creative writing teacher used it in class one day when she asked us to start writing in our journals for 10 minutes straight – without stopping.

She described it as an opportunity to just let our thoughts flow out from our pens without interruption. Anything we wrote didn’t have to make sense…it was simply an exercise in just letting our writing be, in an unrefined and unapologetically honest kind of way.

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What would your diabetes stream of consciousness look like?

When I was struggling to write a blog post for today – because let’s face it, writer’s block is real – the stream of consciousness concept popped into my mind. And I started thinking about it in a diabetes lens, which resulted in this*:

Ugh there’s my alarm blaring again
let me reach for my phone and check my CGM data first thing
okay I will use this to bolus for breakfast what do I even want to eat today
okay let’s go ahead and just get the insulin pumping
input for 30 carbs even though I am not sure that I really want to eat 30 grams worth of carbs but whatever I’m sitting at home all day anyways so I may need any of the extra insulin that gets delivered
finally roll out of bed and make my way down the stairs and eat breakfast and do the crossword like I always do to wake my brain up some more
then set to work and work straight for the next two hours or so I forget exactly how long it was but then my CGM alarm interrupts my flow so rudely OMG why am I this high
okay I guess it’s time to take my lunch break a little earlier than I wanted but my blood sugar is too high and it will distract me further if I keep trying to work through it so I get up and do a high-intensity cardio workout for half an hour
and that does the trick, by the time I jump into the shower my blood sugar is coming back down
oh that’s so much better I sit back in my chair not too long after and get back to work and pause again only to have lunch
I make an egg with an English muffin and also eat a banana for “dessert” though I wish I could have chocolate boy am I craving chocolate lately or what
I pad my bolus with extra insulin because I seem to be trending higher lately which is obnoxious and then I settle in for an hour-long meeting and I’m relieved to discover I’m on mute when my CGM starts alarming again and I’m so fucking exasperated,
I’m high again and it’s probably because of the banana although I can’t really be sure so I start rage bolusing
BAM BAM BAM
get that insulin in my system puh-lease and then I work again for another couple of hours before it’s time for another break and
I go for a walk with my mom and the dog and we’re midway through our usual route when I start to feel those familiar signs of an early low blood sugar some shakiness and some general unease
sure enough when I get home I check my CGM (so many times that I check it throughout the day) and I’ve got a down arrow and I’m plunging into low territory quickly and FINALLY I can have some of that chocolate I’ve been wanting all day
YUM Cadbury eggs.

*I added punctuation and line breaks after writing for five minutes straight just to make this somewhat more readable.

What did I learn after doing this little writing exercise? Diabetes really dominates my mind from the moment I wake up. It is the reason behind just about every decision I make and I don’t really ever get a mental break from it.

But luckily, there’s chocolate for that.

Is Chia Seed Pudding REALLY Life-Changing for T1Ds?

“A Three-Minute Diabetes Breakfast That Changes Lives?”

Whoa, a life-changing breakfast? Sign me up!

Three years ago, that post was published on DiaTribe. I’ve come back to it every now and again with every intention of trying this amazing recipe myself, but it called for ingredients that I don’t usually have on hand.

I mean…chia seeds? Coconut oil? Those aren’t exactly pantry stables for me…and they probably aren’t for many other people.

But during a grocery store trip earlier this month (before things got really crazy), I finally remembered to pick up a giant pack of plain old chia seeds and decided to whip up the recipe.

As a simple Internet search informed me, I was free to play around with the ingredients I added to my chia seed pudding – really play around. Coconut oil wasn’t a requirement; rather, an add-in, and it turns out the only truly needed recipe components are chia seeds and a liquid of some sort. I’ve been using a combination of unsweetened vanilla almond milk and water, which suits my tastes just fine, though I’m sure that just about any other kind of milk out there would work well in this recipe, too.

This is what I added to my first batch of chia seed pudding (which made 4 servings):

  • 1/2 cup chia seeds
  • 1 cup of unsweetened vanilla almond milk
  • 1 cup of water
  • 3 tbsp. vanilla protein powder (I just kind of eyeball it when I add it in)
  • 1 tsp. vanilla extract (adds more flavor)
  • 1 tsp. cinnamon
  • 1/4 cup sugar-free syrup

I combined all the ingredients into a plastic container, gave it a good stir, and let it chill in the fridge for 4-6 hours before giving it a taste test.

And I was pleasantly surprised. It was definitely sweet and had an interesting texture going on – very pudding-like, but with a little something…else going on. I could almost compare it to bubble tea (a.k.a. boba or tapioca pearls).

When I prepped a bowl for breakfast the next morning, I added a little of whatever I had on hand, which was craisins, a bit of granola, and some shredded coconut. Now the challenge was…how do I bolus for something like this? And how would my blood sugar react over the next 3-4 hours?

Is Chia Seed Pudding REALLY Life-Changing for T1Ds_
Sure, it’s not the most aesthetically pleasing breakfast…but it sure does make my blood sugar happy.

I decided to bolus for the toppings, which I figured were about 15 carbs. Ultimately, though, I rounded up to 20 to pad my bolus since I really wasn’t sure how the chia seeds would affect me. (They’re loaded with fiber and even some protein, and sometimes it can be tricky to calculate accurate insulin dosages for high-fiber foods.)

I’m not exaggerating when I say I experienced an incredibly flat post-breakfast line on my CGM.

I was pretty wowed. There was ZERO rise after consuming the meal, and my blood sugar just…held out for hours afterward. So yeah, I’d say it’s pretty effin’ life-changing for THIS person with diabetes…

…except for one tiny caveat: I was hungry again just a couple of hours later. Perhaps I could’ve added more of the pudding to my serving, but it was probably over a full cup that was in the bowl…I had assumed that would be more than enough to tide me over until lunch. Then again, an easy fix could be to add more satiating toppings, like fresh fruit – which I’ve experimented with, and they make a great addition to the mix.

I’ve had chia seed pudding for breakfast many times now, and I’d say the final verdict is that I definitely like it, and my blood sugars seem to LOVE it. It’s probably not for everyone considering the texture is a little “different”, but I’m glad that I took a chance on this highly versatile recipe.

How to Hit Your Step (and Blood Sugar) Goals When You’re Stuck at Home

My diabetes has never liked it very much when I’ve stayed idle for too long.

Unfortunately, my diabetes and I don’t really have much of a choice these days other than to stay put – and I know that just about everyone else in the world is in the same boat.

So how do you hit your daily step goals when you can’t leave the house?

You get creative.

hugging the cactus - a t1d blog
With a little creativity, you can find tons of ways to stay active when you’re stuck at home – which will make your blood sugar and body happy.

And, in turn, your blood sugars will generally respond positively to any extra movement you get throughout the day…plus, with endorphins spiking (instead of bg levels), you can see a huge improvement in your mood. And who doesn’t need a mood booster right now?!

Here are the ways in which I’ve been getting 10,000 steps or more each day:

Taking spontaneous dance breaks. My mom and I are both working from home and sitting in front of our computers for long stretches of time Monday through Friday. To combat this, we’ve come up with a ridiculous but fun game called “DJ Dance Party”. It’s simple: Every couple of hours, one of us cues up music and we just dance around for the duration of the song. DJ Dance Party is a welcome reprieve from work, especially when it happens right after long conference calls!

Playing with pets. Our animals can get just as stir-crazy as we can, so by helping them combat boredom, we’re also doing ourselves a favor by getting off our butts. I play with my parents’ dog, Clarence, by chasing him around the house, throwing his toys at him, taking him for neighborhood walks, and kicking the soccer ball around in the backyard (weather permitting).

Dust off those old fitness videos. Do you have old Jane Fonda/Windsor Pilates/Jazzercise tapes or DVDs just laying around, untouched for years? Dig ’em out from wherever you’ve got them and give them a spin. It might feel silly, but then again you might also get a good laugh in addition to some exercise. I’ve done a few Zumba routines in the last couple of weeks because we have some old DVDs, and they’ve been surprisingly fun.

Hit up YouTube and other fitness platforms for free workouts. Personally, I pay for a subscription to Beachbody, which gives me access to countless workouts lead by professional personal trainers. I’ve used Beachbody workouts in lieu of going to the gym for about a year now and it has worked really well for me, but if I didn’t have the service, I know I could rely on YouTube – in fact, one search of the word “workout” on that platform brought up tons of results that vary in length and intensity. It’s a treasure trove!

Pace around when on conference calls. When I’m not attending a virtual meeting with a video chat component, I’m constantly walking around while I talk on the phone. And it honestly helps me become a more active participant in meetings, sometimes, because I don’t have the distraction of my computer monitors in front of me. I imagine this is the closest I’ll get to having a fancy-schmancy treadmill desk, but I don’t knock it because it works!

March in place while watching TV. Binge on all the TV shows and movies you want guilt-free and challenge yourself by marching in place in 15-minute intervals or at every commercial break. Steps rack up quickly this way, and it’s a go-to for me when I can’t get a walk in during the day.

So even though I’ve barely left the house, doing one, two, or a combination of these above exercises have guaranteed that I’ll meet my step goal each day. And they’ve also really come in handy after meals and long stretches of sitting, when my blood sugars are most prone to going up.

Staying at home has disrupted routines for most people, but it’s good to know that we can still control how much exercise we get in a day.

Consume ALL The Carbs!

See the title of this blog post? That’s basically my mantra lately.

Working from home (and never leaving the house, in general, except to walk around the neighborhood) has made me crave nothing but carbohydrates. Whether it’s in the form of biscuits, chips, chocolate, or cereal…I’ve been mowing down on many more carbs than I typically do.

I guess it’s the way I deal with stress and anxiety. Don’t get me wrong, I’m still eating plenty of fruits, veggies, and proteins…but I’ve also added an unnecessary amount of carbs into my daily diet. So I’m not totally trashing my body, but I am going through a little more insulin than normal. I’m also probably more apt to moving around whenever I can in order to combat higher-than-I’d-like blood sugars.

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Me with all my beloved carbs…and looking like I belong in the 90s with my Lisa Frank sweatshirt.

I can’t help it, I love carbs. They bring me comfort. They’re delicious. They come in so many iterations. But I don’t love how they make me feel (bloated, hyperglycemic, unhealthy, etc.). And I especially don’t love how they cause me to take more insulin than I prefer taking in a single day.

So I’m hoping that by admitting here that I’m overdoing it in the carbohydrate department will encourage me to cut back. Maybe small changes, like chia seed pudding (more to come on that in a future post) instead of cereal in the mornings for breakfast, are what I need to get me back on track. I’m not saying that I’m going to stay away from carbs altogether (oh heavens, no); rather, I’ll just be more mindful of how many I consume in a single day.

Besides making me feel better about myself overall, it’ll help me appreciate yummy low blood sugar treats – hello, Reese’s eggs – during those times that I genuinely need something sweet and carb-o-licious.

The Gratitude Challenge: 5 Things I’m Grateful For

Yesterday, my dear friend Emma (who I did the Ask Me About My Type 1 Podcast with) posted a daily gratitude challenge on her Instagram account. She explained that the leadership training program that she runs teaches participants to develop small habits that change your life. One is to write daily “gratitudes” that help highlight all of your reasons “why”.

I interpret my “why” as the things that keep me going – the positives that help me shine a bit brighter, and the parts of my life that I just don’t appreciate or recognize as much as I should.

The Gratitude Challenge_ 5 Things I'm Grateful For
Will you take on the gratitude challenge?

So I decided to take time to list five of my “gratitudes” in today’s blog post, and like Emma, I challenge you to do the same.

Gratitude #1: My people (and pets). Goodness knows that I could and should tell the people in my life that I love them more often than I do. My people – my family, friends, coworkers – are incredible sources of strength and support in my life. They make me laugh, they are there to console me when I’m upset, and they are always generally around to offer wisdom and a listening ear when I need it. And I cannot forget my pets…Clarence the Shetland Sheepdog and Tyrion “Tater Tot” the betta fish bring me joy on a daily basis.

Gratitude #2: A roof over my head (and all things that come with that). I am so lucky to have a home to live in, a warm bed to sleep in, a kitchen to dine in, a family room to relax in…these are things that I absolutely take for granted during normal circumstances, and I can’t help but feel fortunate to have them given these strange times.

Gratitude #3: The ability to work remotely. These are trying times for working Americans…many people are without jobs right now, and I can only imagine how many families this directly and indirectly impacts. I’m appreciative of the fact that I am able to do my job (and do it well) remotely, and in that same vein, I’m glad that my department employs video chat during meetings – it truly does help me feel that much more connected to my coworkers!

Gratitude #4: The wide array of entertainment options available to me. I have so many universes, plots, and characters to explore right now through various books, television shows, movies, video games…and I finally have time to really delve into them in the coming weeks. I’m particularly looking forward to reading more – I used to positively devour books (I read the last book in the Harry Potter series in about 12 hours). My new nighttime routine is to get cozy and read for at least a half hour before going to bed. I find it to be the perfect escape. Plus, I can continue to pursue my hobbies – knitting, playing the mandolin, crafting in general, etc. – with all of this spare time I’m suddenly finding on my hands.

Gratitude #5: God. I don’t think I’ve ever discussed my religion openly online before, but I am a Catholic and I try to practice my faith in little ways on a daily basis. One thing that I do nightly is pray. When I pray, I have conversations with God, and it has brought me so much comfort in the last several weeks. And even if I wasn’t religious, I’m sure I’d still find it beneficial to meditate or reflect at the end of each day…to mull over the things that went well, and maybe some of the things that didn’t, and focus on the positives of the bigger picture.

Bonus Gratitude #6: It’s kind of (okay, definitely) weird to say that I’m grateful for diabetes…but it’s not the thing itself I’m thankful for. Hell no. Rather, it’s the other things – the people, the wisdomthe self-sufficiency, the experiences – that my diabetes has brought into my life that I’d like to express gratitude for.

Now you know some of my many “gratitudes”…why don’t you let me know yours? Tell me what you’re grateful for by dropping a comment here, or by tagging me on Instagram or Twitter. Let’s see how many people we can get to participate.

I’m Still Here

Hey friends. You probably noticed I didn’t have a new post up this week. (Unless you are one of the few people who saw my incomplete post go up on Monday…I took it down as fast as I could, and the finished version should be up soon. My bad!)

The reason for that is simple: I didn’t really know what to say. We’re living in an interesting time, to say the least, and I didn’t know how to address that on my blog. It seems silly to not address it at all (especially considering I just talked about it a few posts ago). But it also feels inauthentic to continue adding to the already-immense volume of information out there. I don’t feel that I have any commentary to add that would be of any value.

So I’m not talking about our current health situation right now. But that leaves the question…do I still talk about my health situation, meaning my diabetes? Is it stupid to blog about given everything else going on in the world?

Maybe, but maybe not.

I'm still here
I’m still here, making dorky faces.

My diabetes – and everyone else’s diabetes – won’t be going away just because there’s a pandemic right now. So why stop blogging about it? It might be nice for others to have a continuous reminder that they’re not alone with diabetes, not before, not now, and not ever. If sharing my story here helps other people in the diabetes community feel more connected in this time of social distancing, then I’m more than happy to keep telling it.

Plus…I think it’ll be good for my mental health (and hopefully for that of other people) to have something to write/read that won’t be anxiety-provoking.

Anyways, I just wanted to give you all a friendly little wave with this blog post – *waves energetically* – and let you know that I’m here if you need someone to talk to. Let’s all remember to stay human amid the chaos: Be kind, help others when you can, and we’ll weather the storm together.