The Worst Time to Change a CGM Sensor or Pod

I’m not kidding when I say I think I’ve definitively identified the worst possible time to change a CGM sensor or pod – of course, I can only speak to a Dexcom CGM sensor and an Omnipod, so it’s probable that the worst time to do a site change may vary depending on the specific piece of equipment being used.

But I’ve learned from my own experiences that the worst time to do a site change is within a one-hour window of taking a shower.

Unless you want your pod to fall off and look sad like this one, maybe avoid changing it before taking a shower.

This is because I’ve found that the sensor or pod adhesive needs a solid block of time to firmly adhere to my skin. If I shower soon after completing a site change, I can almost guarantee that the heat and steam from the shower will be enough to dissolve the adhesive and cause the sensor or pod to fall off.

I’ve played around with the timing, too, and I’ve discovered that the more time I put in between a site change and shower, the better – an hour seems to be the absolute minimum. It can be a little inconvenient in the times that I have to forgo my CGM data for a longer period than I’d like, but my goodness, is it wonderful when the stars align and I can take a completely device-free shower. This doesn’t happen often as my sensor and pod change days don’t usually happen on the same day, but it’s undeniably a nice break when it does.

So, there you have it – a word of caution from me, a semi-pro CGM and pod wearer with about a decade’s worth of experience wearing both devices – the worst time to undergo a site change. A pod or CGM failure almost always can’t be helped, but I think it’s worth knowing how to prevent the likelihood of one or both of them needing to be replaced sooner than expected.

Sluggish

Pasta for lunch. I knew it was a gamble, but on a snowy Friday afternoon when I had a bowl of leftover spinach-stuffed ravioli in the fridge that was begging to be heated up, I simply couldn’t resist it.

I took a larger-than-usual lunchtime bolus to account for the heavy carbs. Or at least I thought it’d account for the carbs. But I was way off. Roughly 45 minutes after I gobbled up my meal, my blood sugar was beginning to take off – with no sign of a smooth landing in sight.

Not that I noticed. Rather, I found myself feeling…slow. My eyes felt droopy with a gradual drowsiness that I couldn’t fight off. Normally, this would feel quite pleasant, especially if I was about to take a nap. But on a Friday afternoon, when I had some work items to wrap up, it was far from a welcome sensation.

As I sat there, staring blankly at my monitor and pretending I couldn’t hear my buzzing CGM that was trying to alert me to the current state of my blood sugar, I was falling deeper and deeper into a state of utter sluggishness. I craved the warmth emitting from my space heater by my desk, relishing how the heat lulled me into listlessness.

In that moment, I was the human equivalent of a happy little slug, oblivious to the realities around it and going about life at my own passive pace, without a single other care in the world.

A representation of me as a slug in a high blood sugar stupor, complete with pod.

I don’t remember what caused me to snap out of my stupor – perhaps I’d heard my CGM vibrate one too many times, or maybe common sense jolted me into realizing that I had stuff to do and couldn’t afford to be overcome by this sensation. But I did find myself peeking at the number that my Dexcom was reporting to me and being somewhat appalled by my hyperglycemic state, as well as being almost grateful for having a logical explanation for why I’d turned into a slow-moving shell of a person. It’s funny how even after 25 years of diabetes, a high blood sugar can still throw me off my game in such a dramatic way. Luckily, a solid correction bolus, change of scenery from my overly cozy desk in my bedroom to the cooler comfort of my downstairs setup, and a large bottle of water brought me back down to where I needed to be – maybe a bit more slowly than I would’ve liked, but hey, a slug can’t complain about swiftness (or lack thereof).

An Almost Seamless Transition

Small blessing. A stroke of luck. Straight-up good karma. Whatever it was that made 1) my overall transition to a new healthcare plan and 2) my receipt of all my necessary diabetes medications and supplies so completely smooth this month, I’m extremely grateful for it – and kind of amazed that it all went so well.

See that above block of text, folks? It’s the reason why you don’t finish writing this type of post until you know exactly what’s gone right and wrong in the transition to a new health plan.

You see, I was counting my chickens before they hatched because, well, things really did go superbly when I refilled some of my essential diabetes medications. I was blown away by how easy it was to obtain my Omnipod 5 pods and my insulin, and even more so stunned by how much my plan covered for both. In fact, I can’t remember a time in my life that I had to pay so little for a 90-day supply of insulin, and for that I remain extremely grateful and very aware that not all people with diabetes have the same experience.

However, getting ahold of sensors and transmitters for my Dexcom G6 was another story. When I told my doctor’s office about my new health plan, I also provided them information from my prescription and health ID cards that they would need in order to get my prescriptions refilled. They took care of contacting my new mail order pharmacy (OptumRx), who sent me my pods and insulin in a timely manner. When I didn’t see any updates from them regarding my Dexcom supplies, I took it upon myself to log into their patient portal and see what kind of information I could uncover there.

I realized that I had a balance to pay for my insulin, so I did that and saw an option to order more Dexcom supplies. Fantastic! Or so I thought. When I hit “submit order”, I was brought to a page on the website that showed me the newly generated order status for my Dexcom supplies…as well as an order total. And that order total was nearly $2,000.

That couldn’t possibly be right…was my first thought. My second thought was to call OptumRx directly and ask if additional information was needed before the order was processed. Maybe my doctor’s office needed to submit a prior authorization in order for me to get my Dexcom at a lower cost. Maybe the system miscalculated. Maybe my Dexcom really would be this expensive under my new health coverage, at least until my deductible was met. Whatever it was, I vowed right then and there to get to the bottom of it so I could get by knowing that I’d done my due diligence on the matter.

One 10-minute phone call later, and I had an explanation: For some reason, OptumRx had duplicated my account information. The representative that I spoke with didn’t really elaborate on this; rather, she muttered here and there as she seemingly went through my data and cleared out information that was repetitive or irrelevant to me and my needs. By the end of the call, she was reporting that my Dexcom sensors and transmitters would cost me roughly $500 for a 90-day supply (infinitely better than 2 grand) and she processed the order so I’d receive everything in just a few days. Finally, just about three weeks into the new year and my new health plan, and I was on track to have all the diabetes supplies I need. Those three weeks are nothing compared to what I’ve dealt with in the past, but it definitely felt like a long time considering all the uncertainty and nerves I felt about costs.

Ultimately, I suppose that my almost seamless transition will serve as a reminder to be appreciative when things go in my favor, and to enter into full-on detective mode when they don’t so I can get what I need, when I need it. And I guess it doesn’t hurt to try and remember that having a back-up supply of all major supplies on-hand at all times can be an absolute saving grace. In this particular scenario, it’s the reason why I never really panicked because I knew that I had a reserve to fall back on, and that I wouldn’t let it deplete until I had all my ducks in a row for replenishing it.

What It’s Like to Wear a Medical Device 24/7

This was originally published on Hugging the Cactus on May 7, 2018. I’m sharing it again today because for as long as I continue to wear an insulin pump and CGM, I know that this is a question that I’ll be asked. Wearing these pieces of medical technology almost all the time has certainly changed how I feel about my body and my body image, and I elaborate on that below…

A question I’m often asked is: “Can you feel your CGM or insulin pump on your body?”

The simple answer to that is: usually, no. It’s something that you just get used to. You grow accustomed to seeing a lump underneath your clothing. You adjust to putting clothes on (and taking them off) carefully to avoid accidentally ripping a site out. You acclimate to showering without being completely naked.

And, of course, you get used to the questions from strangers asking about that device stuck to you.

But the more honest answer to that question would be that there are times that I feel it more than others. For example, sometimes I forget where I’m wearing my pump until I hit it against something (I’m a major klutz who constantly runs into doorways and trip over things, almost always managing to catch my pod on whatever it is), resulting in pain at the site and a curse word or two to fly out of my mouth.

I feel it the most, though, when people stare. Whether unconsciously or purposely, people do ogle at it in very not subtle manners. Which makes me feel extremely uncomfortable. It’s worse when they don’t even ask me what it is – I’d rather have a chance to use it as a teaching moment than to have someone walk away not knowing what the device does. This tends to make swimsuit season a little less welcome for me. Nothing will stop me from donning a bathing suit at the beach or by the pool, and I do so as much as possible in the summertime. But it’s just not as fun when I’ve got to cope with lingering looks, especially when I’m an admittedly insecure person in the first place.

So it’s a more complex question to answer than you might realize. Wearing a medical device 24/7 is humbling. It keeps me alive. I’m privileged to have access to it. I’m grateful for the ways it’s improved my life. I’m always wearing it, but it’s not at the forefront of my mind – unless it chooses to make its presence known by alarming, or I’ve got people blatantly checking it out. It’s kind of like diabetes itself. It can make you feel a gamut of emotions, but no matter what, it’s always there. It’s just a part of me, and I can deal with that.

My #1 Piece of Advice for Any T1D Who Wants an Insulin Pump (or Wants to Switch Pumps)

As someone who was so stubbornly resistant to the idea of switching from multiple daily injections (MDIs) to insulin pump for my entire childhood with T1D, I surprised myself quite a bit when I finally decided, around age 21, that I was ready to start using a pump.

And I haven’t looked back since I made that choice – that’s how much of a difference it made for me.

In my almost 10 years of pumping, I’ve realized that there is one, major piece of advice that I’d share with anyone who is looking to make a similar switch, or even go from one pump to another. It doesn’t matter if that person is newly diagnosed, a diabetes veteran, or somewhere in between. Or if a person is a pro at adapting to new technology, or wary of any kind of electronic device… because in my humble opinion, this advice applies to all. So what is it?

Don’t do it alone.

When I started using an Omnipod back in 2015, it was with the help from a team that included my endocrinologist, a diabetes care and education specialist, and a more experienced Omnipod user who I actually lived with – my mother. It was the guidance that all three of these people gave me that ensured a fairly easy transition to pump therapy.

My experience was starkly different when I went on the Omnipod 5 late this past summer. In a word, I was too cocky about it. I thought I knew enough from my prior pod experience, and had enough exposure to all the literature that had come out about the Omnipod 5, that I could make this upgrade just as seamless as it was to start up pump therapy in general. And that was most definitely not the case. I struggled for the first 8-10 weeks of life with the Omnipod 5, and it was such a rollercoaster that I seriously questioned whether or not I’d made the right decision to try out a more advanced pump.

Of course, I don’t regret switching to the 5 – not at all – now. That’s because I did finally get help, first from the nurse practitioner at my endocrinology office, and then from an educator at Omnipod who was really able to explain the 5’s algorithm to me and suggest changes that ended up working wonderfully for me within days of our conversation. It just goes to show that it’s okay to reach out for help when I’m feeling stuck with my diabetes (or when I need it in any other facet of my life, to boot), and I’m here to remind you of that, as well. Don’t do it alone. Lean on your community. Get support from healthcare professionals. And you’ll be amazed by the outcome.

Feelin’ Odd About my Pod

I don’t often perform pod changes in public. This is mainly due to the fact that I’m most comfortable changing my pod in my own home, where I have all my supplies readily available…and more importantly, it’s where I feel safe taking off a pod from an old site and putting a fresh one onto a new location.

So you can imagine the level of unease I felt when I had no choice but to change my pod at my office for the first time since starting my new job.

I did this plenty of times at my last office job, but that was always behind the privacy of a closed conference room door that I could lock and that nobody could see into. This level of discretion meant that I could take my time with my pod changes without worrying about someone seeing me and getting the wrong idea about what I was doing (even I can admit that it looks a bit suspicious to see someone in a non-hospital setting drawing an unidentified liquid out of a vial with a syringe).

Both fortunately and unfortunately for me, my new office space is so modern in its design that every single conference room is encased with glass walls and doors – making it all too easy to peer inside each one to determine whether or not it’s occupied. That’s great for off-the-cuff meetings, but not so much for someone who needs just 5 minutes to change an insulin pump site.

Due to the lack of privacy in my office suite, I had to venture out to the main building bathrooms as a next resort. But I wasn’t just going to use any old bathroom. No, I sought out the one that had what I suspected to be the least amount of foot traffic and also the cleanest sink, because I most certainly was not going to lock myself into a stall to ensure more privacy when changing my pod. Absolutely not. Sure, it would mean that I had the stall door blocking me from view, but it also meant I’d have to change my pod without a table in front of me to put my supplies on, and I wasn’t about to do that because it would virtually guarantee that I drop something on the unsanitary bathroom floor – or worst-case scenario, maybe even break my vial of insulin. I wasn’t about to risk that, so I set about changing my pod at the bathroom sink, keeping my fingers and toes crossed the entire time that nobody would walk in while I was at any stage of the process.

My mission was accomplished; a few moments later, I was rocking a brand-new pod and also marveling over how something fairly mundane (because I do it every 72 hours or so) could cause me such anxiety and make me feel self-conscious about needing to do this medically necessary routine in public. I’m not accustomed to feeling odd about my pod and the maintenance actions I take to keep it running smoothly – and to keep myself healthy, to boot – but there’s a solid, highly realistic chance that I’ll have to publicly change my pod again in the future. Hopefully, I can work on it so that changing my pod, whether within the walls of my own home or in the most public of locations, is something that I feel normal about doing, and worry less about whether or not people are judging me over it.

The Best Laid Plans

You know what they say with the best laid plans…

…something always goes awry with them. It doesn’t matter how meticulously pre-calculated they are, or when/where they take place – sometimes, they just aren’t meant to be.

Such was the case with my Christmas plans this year. (And a partial reason why I’ve fallen behind on my twice-per-week blog posts.)

I know, I know – I had written a whole blog post about how I was going to spend Christmas, particularly Christmas Eve, celebrating my diaversary in the company of my loved ones. And I did…sort of. Except it was just one loved one, who unfortunately had tested positive for it-shall-not-be-named just a day before.

Even though he was entirely asymptomatic – and I was testing negative with at-home test kits and a PCR test conducted by my primary care doctor – we decided it was best to stay away from others and skip out on our highly anticipated Christmas Eve plans with my family. It was pretty devastating, but I’d be remiss if I didn’t count my blessings over the situation. First of all, my partner was feeling great (seriously, it was a completely different experience compared to what we both dealt with when we fell ill with the same condition this past spring) and I was on the road to recovery from a mild head cold I’d been dealing with. Second, we were still able to make the most of the holiday by going for a ride around town to see lights in the neighborhood and ordering sushi to feast upon at home while watching Christmas movies. It was an enjoyable way to spend the holiday, but I definitely missed my family and was a bit heartbroken I couldn’t see all my relatives as I’ve done my entire life, every Christmas Eve.

The only thing missing from the whole ordeal – besides my loved ones, of course – was that I didn’t think about my major diabetes milestone of officially living with diabetes for 25 years, not once, throughout the entire day. My mind was far too preoccupied. But now, in hindsight, it’s serving as additional proof to me that diabetes isn’t always at the front and center of my mind. Sometimes, there are things that take precedence over it. And honestly, that’s a pretty cool thought for me to hold onto, especially on the days where it seems like diabetes is determined to ruin everything for me.

It’s only in charge when I allow it to be. I have ultimate control. I can’t think of a better message to be driven home to me on my 25th diaversary (rather, in the days following my diaversary).

‘Betes and Burns: Playing it Safe

If you told me that I would get a second degree burn on my fingertip from a dish that was in a microwave for a measly 24 seconds, I would’ve laughed in your face.

But then I would’ve apologized immediately to you, because such a thing actually did happen to me a few weeks ago.

The full story isn’t particularly exciting; in fact, it’s as boring as it gets. But for the sake of context…I’d put a tablespoon of butter in a ramekin so I could melt it in the microwave for a recipe that I was making. I knew it would likely take fewer than 30 seconds for it to melt completely, so I stopped the microwave a little early and used my bare hand to take it out. The moment my fingertips met the ramekin, I became acutely aware that the dish had overheated – I couldn’t believe how blazingly hot the exterior was. I dropped the ramekin in the sink almost immediately, but the milliseconds of contact it had with my skin was enough to create a blister on my right middle fingertip that burned painfully for the remainder of the day.

I was quick to put some bacitracin and a bandage on the injury, but reluctant to expose the blister in the ensuing days as I didn’t want to exacerbate the wound (and honestly, it was unsightly, so I was eager to keep it under wraps so I didn’t have to look at it). So I changed my bandage every 24 hours or so, taking care to wash and dry my hands completely before applying a new band-aid.

But roughly one week after the injury occurred, I noticed that the blister was swelling. I peeked at it between bandage changes and saw that it was white and bubbly in appearance – totally gross, but also worrisome as it looked like it might pop should I strike it on any surface in just the wrong way. That’s when I made the executive decision to see my primary care doctor to get a medical professional’s opinion on the matter.

And I’m glad I did. I got confirmation that it was, indeed, a second-degree burn and that I’d done the right thing to keep it covered up. My healthcare provider reminded me that as a person with diabetes, I should do everything I can to avoid infection, so applying antibiotic ointment and keeping an eye on the wound was smart thinking. But I was also advised to remove the bandage when I went to sleep at night so the injury wouldn’t stay super moist for prolonged periods of time (added bonus that I could let it air out overnight while I was asleep so I could again avoid looking at it). More than two weeks post-incident, the burn is healing nicely as the skin grows healthier and I no longer need to wear a bandage over it.

What’s the point of this little anecdote about my kinda ridiculous, definitely painful injury? It’s that it’s always better to play it safe, just as my healthcare provider commended me for doing so. Silly injuries like this happen, but it’s important to roll with them when they do and act accordingly instead of just shrugging them off.

All health matters…well, matter when you have diabetes, and I’ve learned to look out for myself by checking in with my team whenever I’m concerned about something.

It’s More Than a PDM

My PDM (Personal Diabetes Manager) is more than just a medical device. It’s basically an extension of my body at this point.

Much like people treat cell phones as a must-have-on-me-at-all-times sort of item, that’s how I feel about my PDM. I carry it (and my cell phone, TBH) around as a small but mighty stack of technology. When I set it down somewhere and struggle to recall where I left it, I panic and can’t focus on anything else until I’ve found it. I make sure to keep the battery charged, and would argue that I get more concerned if the battery is low on that device than I do with my phone. And I’d sooner give my phone over to a toddler to play around with than consider handing off my PDM, even to a trusted family member or friend.

It’s more than just my PDM, it’s a lifeline.

In a world that remains ever-increasingly reliant on technology, there are times where I certainly wish I didn’t have to depend on my PDM so much. It would be nice to not have to carry it around all the time and fuss over it, making sure it’s charged and working properly. But just when I start to grow resentful of the device, I remember how much easier, overall, it’s made my life. It’s given me freedom that I wouldn’t have discovered if I’d chosen to stick to multiple daily injections. I also believe that, combined with my Dexcom CGM, it’s responsible for my improved blood sugars and time in range into my adulthood.

So even though I didn’t exactly wish for a PDM to be an extension of my very being, I’m glad that it is, because it’s proven to be a valuable piece of equipment in my diabetes care toolkit.

25 Years

This Christmas Eve marks 25 years since I was diagnosed with diabetes.

25 years feels like a significant milestone – and that’s because it is. Diabetes has been my “normal” for that entire length of time; I don’t remember what it’s like to live free from its burden.

I accepted that long ago, but still experience some sadness and bitterness over it from time to time. Can you blame me? There are times when I find myself envious of people with diabetes who were diagnosed later in life and have memories that remain entirely unimpacted by diabetes, but when I find myself getting swept up in morose emotions, I ground myself by remembering that (as trite as it may seem) everything happens for a reason. My diabetes story has taken very deliberate twists and turns, whether or not I was aware of them when they were happening. Each and every challenge, all the emotions, and the many experiences and relationships it has brought into my life were bound to happen, and I’m glad that they did because they’ve made me who I am today.

And today, just a few days shy of officially celebrating my quarter-century diabetes diagnosis, I find myself once again being so happy that it’s happening on a day that I will be around so many of my loved ones. I say it every year, but having my diaversary on a major holiday makes the celebration that much more special to me. The day is always more about spending time with my family than it is about diabetes. Instead of sadness, I feel joy in the reminder that diabetes can’t and won’t overshadow Christmas or any other day for that matter.

So here’s to 25 years of a life enriched and uninhibited by diabetes – and many more to come.