My Thoughts on Returning to Work (and this “New Normal”)

We all know that 2020 hasn’t exactly gone to plan so far, largely thanks to COVID-19.

In a word, the last 8-10 weeks or so have been…weird. Collectively, the world experienced a lot of things: shock, rapid-fire adjustments, loss, and more than anything else, change.

It goes without saying that I’ve been very fortunate given the circumstances. I’ve had my job throughout this whole ordeal, and I’ve had experience working from home before which arguably made my transition to full-time remote work a little easier. While each week has come with its own unique set of challenges and emotions, there’s no denying that I’ve had it pretty good, overall, these last couple of months.

But now, along with everyone else, I’m about to enter a “new normal” (gosh I hate that term) as states begin to re-open. And with this “new normal” comes the possibility of returning to a physical office building each workweek.

I’ll admit that the sheer thought of it simultaneously excites and terrifies me.

My Thoughts on Returning to Work (and this _New Normal_)
My thoughts on re-entering the workplace are…complicated.

On the one hand, I’m yearning to go back to work in an office space. I miss my little cubicle, office camaraderie, and meetings that are held in-person, in conference rooms, as opposed to virtually.

On the other hand, I’ve never felt more anxious about returning to a space that is shared by people other than my family members.

There are a LOT of people that enter and exit my company’s building throughout the typical workday. There are at least a dozen other companies besides mine that occupy the other floors in the building. Tons of deliveries are made to these office suites each day. While there are custodial staff who do their best to keep the building clean, it can be…a challenge, as anyone who has seen our bathrooms can attest to.

Basically, I suppose that I’m feeling incredibly nervous about the exposure to germs that is bound to happen upon my return to the office.

Even if I didn’t have diabetes and wasn’t considered at a higher risk for COVID, I’m sure I’d still feel worried because it’s not just about me: It’s also about the people I live with. I’d never want to bring anything harmful into my family’s home, period, bottom line, end of story. And while the odds are pretty damn high that PPE (personal protective equipment) will become standard when re-entering the workplace, it does little to placate me because I’ve seen firsthand how sloppy people can be when it comes to wearing it or disposing of it properly.

And so, with much still unknown about COVID, it just seems like a giant gamble to resume working in an office environment when I can’t be sure that I won’t be exposed to anything.

As it stands right now, I don’t have a concrete “return to work” date. And I don’t know what exactly it will take in order for me to feel totally comfortable about returning to the office. But I do know that I’m cautiously optimistic for a smooth transition to a “new normal” that is safe for all.

Bloody Dexcom Sensors: No Go or A-Okay?

This post was originally published on Hugging the Cactus on February 18, 2019. I’m re-posting it today with some updates because I recently noticed this post gets a LOT of clicks – this topic is one that many people are curious about it. Read on for my two cents on whether or not bleeders are readers, and note that I haven’t updated this because my experience with bleeders remains the same…

I placed the new Dexcom G6 sensor on my abdomen, hovering my index finger above the large orange insertion button. I pressed it, exhaling as I felt the minute needle pierce my skin’s surface. I looked down, and started to rub the adhesive in circles to make sure it was stuck, when I saw blood. Not just a drop, but a decent-sized pool forming beneath the sensor. Before long, just about the entire surface of the white adhesive was soaked in red.

Yeah, this was going to be a no-go.

It’s pretty rare for me to experience blood at the site of a Dexcom sensor. If I had to put a number on it, I would say less than 10% of my insertions draw blood. An even smaller amount – like, 2% – have caused me to bleed as much I did in the scenario described above. But I know I’m not alone in my bloody sensor experiences – it’s something that many other T1Ds who use a Dexcom have gone through.

There’s a bit of debate, though, that I’ve noticed in the past on Twitter threads and Instagram posts. What to do with a bleeder? Keep it and assume that it’ll read blood sugars normally? Or change it immediately and call Dexcom for a replacement?

Are bleeders readers? Or does it depend?

Bloody Dexcom Sensors_ No Go or A-Okay_
Do you think that bleeders are readers?

I’m going to go with…it depends.

Obviously, in that situation I described in the opening of this post, I decided that it wasn’t a good idea to keep the sensor on my body. There was too much blood and I didn’t trust that it would adhere well to my body. I didn’t know how long it would take for the blood to stop (only a few minutes, but still), and I couldn’t be sure that it wouldn’t mess up my readings. On top of that, I wasn’t trying to stain my clothing, if I could help it.

So in that circumstance, I did change my sensor right away, and was glad that the second try resulted in a much cleaner, blood-free insertion. I called Dexcom, explained what happened to the customer support representative, and got a replacement sensor mailed to me.

However, just about any other time I bleed upon a sensor insertion, it tends to be a minuscule amount of blood. I usually don’t even notice until it’s time to replace the sensor, and there’s a bit of dried blood left on the site. Other times, I’ll see small beads of blood forming underneath the spot where the transmitter snaps in. And there’s been a couple of occasions that I’ve bled a fair amount and been totally unaware of it until I caught my reflection in the mirror and noticed the blood staining the white adhesive. And in all of those cases, I’ve kept the sensor on for the full ten days, without noticing any discrepancies in my readings.

All that considered, in my inexpert opinion, I think that bleeders usually are readers and that they’re safe to continue wearing. Of course, there will be exceptions, like when there’s just too much blood to salvage the sensor. But every time I’ve kept using a bloody sensor, I’ve had the same amount of success with its functionality…so yes, I think that for me, bleeders are indeed readers.

10 Countries, 10 Global COVID-19 Perspectives

This blog post was originally published on the T1International website on April 10, 2020. I am highlighting it here on Hugging the Cactus because 1) I think it sheds a lot of light on the healthcare systems in other countries and 2) it’s a reminder that we’re all in this together.


Hear from ten people living with type 1 diabetes as they share their perspectives about the impact of the coronavirus on their country and their health.

Bolivia – Laura
Things are complicated here, and our health system is already problematic. There are no masks and a lack of other correct equipment to treat patients. The government has been very careful about prevention, and quarantine has been going on for several weeks already. Many people are poor and live day by day with what they earn. The government began to give money and food aid to older people and families who receive other types of government bonds, but not everyone can receive it and many say that they do not have enough money to eat. Based on the numbers on our identification, we know when we can go out to get groceries or medications – only on specific days. Still, there is a lot of ignorance and people are not following instructions. There are 200 cases confirmed, with 15 deaths and it is increasing every day. People who have to travel long distances to get medicine do not have good options. I have a friend who has no blood glucose test strips and her blood sugar keeps going too high, but because she does not have test strips, she doesn’t know it. It is very dangerous.

Costa Rica – Dani
Our small country is on lockdown, with only 10 people in ICU at the moment. The country is making at-risk patients a priority and currently even shipping their medicines to them to prevent them from going to the hospital and getting infected. Families have been given extra insulin for the next two months, and the community is supporting each other if there is an urgent need for support or extra supplies.

Germany – Katarina
Germany has one of the lowest COVID-19 related death rates so far. A lot has been undertaken to prevent the virus from spreading – test centres have opened their doors to the general public, hospitals are increasing their capacities for intensive care and ventilation, and research teams are working hard to improve diagnostics, therapy and find preventative methods. The pandemic is challenging our healthcare system, our economy, and our society, but it also opening new pathways. A lot of diabetes care centres are transitioning to telemedicine, and people with diabetes can get prescriptions and supplies by mail. Being a doctor on the frontline and a high-risk patient at the same time is not easy – I am constantly torn between my profession and my wish to self-isolate and stay safe.

Ghana – Yaa
With the rise in COVID 19 cases in Ghana, the government made it mandatory to close down schools for a month, to limit the number of people to no more than 25 in a social gathering, and to start a two week partial lockdown in contiguous districts (3 regions). This means no one is allowed to go out unless it is to buy food and drugs. Borders are closed, and importation of goods are restricted. For people with type 1 diabetes who get supplies at the government hospital using the national health insurance scheme, they still have to go all the way to the hospital for their supplies. The hospital is a major reservoir of the virus, so it increases the chances of people with type 1 who are already at high risk. The only other option is to go buy from the pharmacies, where there is currently a surge in prices. People with diabetes were asked and encouraged to stock up on their diabetes supplies, but not everyone was able to do this. We fear for the unknown and the long term impacts.

India – Apoorva
As a medical doctor I have been working and seeing new cases, but now my entire department is in isolation. I took steps back to prevent getting sick. Delhi is one of the hotspots, and we had sudden surge in cases. Rural impoverished areas are problematic due to people living in close quarters. Our government initiated a lockdown, but many tried to leave quickly, especially migrant workers who come and go from the city centres because they lost their livelihoods. This caused the virus to spread despite drastic measures taken by the government. Currently, there are no insulin shortages as all medical services and pharmacies are operational, but we have seen a possibility of analogue shortages and hope to try to ensure that does not happen. Our main aim is to support the actions of the government and I plead everyone to stay home and protect their families.

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Kuwait – Mohammad
We have been on lockdown for four weeks, and people who came to Kuwait from other countries were tested. If someone had symptoms, they were put in quarantine. Cases have been contained and so far, there has only been one death. It is interesting that there is now a COVID-19 database that was created rapidly, but there has never been a database of people with type 1 diabetes in Kuwait. Our medications tend to be provided and some are being delivered. Overall, things are OK now, but we are concerned about access to medication and food supply in the long term because most of it is imported.

Lebanon – Cyrine
Our country has been facing tricky political problems for the past five months, since we had a revolution in November. The banks have no money, and there is no money from the government. We can only have access to a specific amount of our money per month. We are facing shortages of medical supplies including ventilators and medical protective equipment. The whole country is in an emergency state now and there are military personnel on the streets. As cases continue to rise, people are only allowed to go out at certain times and we can only walk. I have been on self-quarantine for the past few weeks. What worries me most is the people who already struggled to afford their basic insulin and supplies. With 80% or more of the population having lost their jobs, what are those who cannot afford their insulin doing now? I am trying to help those I know about, but there is no government plan for people with type 1 diabetes. People do not have money anymore, so how can they cover their insulin costs?

South Africa – Estelle
Testing here is slow. On April 2nd, I heard only 46,000 tests had been done, which is not even 1% of the population. It looks like we have small numbers of diagnosed patients but there is so much unknown. Apparently there is enough stock of medication for up to a year. Medical aid, our version of insurance, said they will cover all treatment related to COVID-19, so that is a relief. A large proportion of individuals might not be taking it seriously enough. The biggest concern is keeping the virus out of the rural areas, which are densely populated. If it spreads there, it could be catastrophic because we do not have enough hospitals.

Tanzania – Johnpeter
We only have about twenty cases identified so far. I am currently in Serengeti which means I am far from cities where cases were confirmed and spreading. I am staying put and I had to cancel my doctor appointments and other appointments. I have had to reduce my insulin dose because I cannot get any insulin here in this rural area. I have some insulin in Dar es Salaam that my doctor gave to my brother for me. So right now I am working with my brother to try to find a way to get the insulin. I am not supposed to travel to cities to risk my health, but I am risking my health by staying here without insulin. It is incredibly stressful on top of the challenges I already face accessing and affording my insulin.

USA – Karyn
In Georgia, where I live, we are also on lockdown, with cases increasing every day. The biggest issue is shortages of ventilators and protective equipment for hospital staff. Cost and affordability issues are already a problem in the USA and this will likely be an even bigger challenge now. Due to the broken healthcare system here, it’s uncertain if people will even get tested if they go to the doctor. Some people are getting billed for the test even though it has been said they shouldn’t be. Last year around this time, I went to Canada to buy a year’s supply of insulin. I have a bit more, but I’m not sure what I’m going to do without being able to travel abroad this year. I already struggle a lot with the costs. Many people are losing their jobs, and therefore losing their insurance, which will inevitably also impact their ability to afford essential medicines.

TTFN, Twitter

The title of this post really should be “Sorry Twitter but I haven’t been an active user in about two and half months for some specific reasons I’m about to highlight here, but hopefully I’ll come back to you later when things settle down,” but that’s just not very catchy, is it?

Anyways…

The reason why I’m saying ta-ta for now, Twitter, is that it’s become a really tough space to dwell in – or even pop in for a quick visit – throughout this pandemic.

It’s nothing that any account that I follow did or tweeted specifically…it’s just an amalgamation of everything that appears on the site these days. Between the news alerts and downright depressing tweets showing up left and right on my feed, it’s taken a huge hit on my mental health.

TTFN
I’ll return to Twitter full-time…eventually.

It’s a shame because for a long while, Twitter was kind of my go-to in terms of connecting with the diabetes community. I participated in weekly diabetes social media advocacy chats that were a lot of fun and a great way to communicate with fellow T1Ds near and far. But as Twitter grew more and more negative for me, I found myself gravitating more towards Instagram, where things are admittedly a little too shiny/happy/beautiful/perfect all the time. Instagram doesn’t quite fill the void that Twitter did for me in terms of linking up with my T1D community, but it’s something steady I can rely on for now, and with the added benefit of introducing me to other T1Ds who might not be on Twitter.

I’ll end this post by saying that I doubt I’m the only one who feels this way about one or more types of social media during the pandemic. Actually, I know FOR SURE that I’m not the only one who has felt emotionally drained by logging into different platforms and seeing just the one post that is enough to sap you of all positive, happy feelings. And you know what my advice would be to anyone who has felt the same way as me? Recognize it by avoiding those platforms for as long as you need to. I deactivated my Facebook profile for a couple of different weeks so far this year and my mental health absolutely benefited from me doing so. I don’t tap on the Twitter app on my phone lately and I know I’m saving myself from a ton of anxiety and emotional turmoil.

Just like the world has adapted to this “new normal”, it’s all about being pliable enough to see what does and doesn’t work for your mental heath right now, and then identifying alternative ways you can support it.

5 Questions (and Answers) About the Dexcom G6

This post was originally published on Hugging the Cactus on November 19, 2018. I decided to update it, since some of my thoughts and observations on the Dexcom G6 have changed over time due to more experience with it. Updated answers will be in parentheses and/or italics just below (and in some cases, next to) the original answers…

I’ve been lucky enough to have the Dexcom G6 CGM in my life for just over six months now. (It’s actually been about 2 years at this point!) In that time, many people in my life – both T1Ds and non-T1Ds – have asked me countless questions about my experience with the device. I thought it’d make sense to address some of the most commonly asked questions here, in the hopes that I can provide some insight to those who are curious about the Dexcom G6.

Question: Can the Dexcom G6 be restarted?

Answer: In my experience, no. I cannot get the G6 to restart like I could get my G5 to restart. But take my “no” with a grain of salt, here, because I know of other people who HAVE had success restarting their G6 sensor, making its life extend much longer than the 10 days guaranteed by Dexcom. I have only tried to restart the G6 once, with absolutely zero success, following the process outlined here. My advice to those who want to try to restart their G6 is to do so cautiously, and make sure you’re not trying to do so with the last sensor in your stockpile.

Since I initially wrote this, I WAS able to restart the G6 and did so “successfully” a handful of times. But in my opinion, it wasn’t worth it because 1) the sensor would stop reading blood sugars 2-3 days after restarting and 2) I can’t be sure that restarting doesn’t wear out my transmitter faster, which wouldn’t work to my benefit since I don’t know how to reactivate transmitters. My two cents is that while reactivating old Dexcom models like the G4 or G5 often worked well, the technology within the G6 simply isn’t meant for accurate restarting.

Question: Is it actually safe to take acetaminophen (Tylenol) on the Dexcom G6?

Answer: Yes! I’ve noticed that acetaminophen can be taken safely on the G6. I did not anticipate for it to be unsafe, seeing as it was advertised as one of the big improvements Dexcom made from the G5 to the G6. I’ve taken Tylenol a handful of times without noticing any issues with my CGM readings, but as always, be sure to monitor your blood sugar carefully and perform a manual finger stick check if your symptoms don’t match up with your CGM.

This is still absolutely true! I’ve yet to observe Tylenol, or any other drug really, having an impact on my CGM’s readings.

Question: I can’t get my Dexcom G6 sensor to stay put for the full ten days. How do you make it last?

Answer: There’s tons of ways you can help ensure your G6 sensor stays stuck on for the entire ten-day duration. I always make sure that my skin is completely dry before the sensor makes any contact with the site. Avoiding any excess moisture is key in helping it stay put. If I notice the sensor starting to peel around the edges after a few days of wear, then I use a Pump Peelz CGM adhesive to keep it in place. Those tend to work really well for me. In times of serious adhesive doubt, I also use Skin Tac wipes, which basically glue that sucker down. One last tip I recommend is to avoid sites that come into contact with a wide variety of surfaces. In other words, a sensor that’s placed on the abdomen may fare better than a sensor on the leg, because the odds of the sensor getting accidentally knocked off due to contact with clothing or other objects are lesser. You know your own body better than anyone, though, so trust your own judgment when it comes to CGM placement.

So at the time of publication, I hadn’t tried my leg as a site for the CGM. Now that I have, my answer changes a little regarding the “usability” of this site: I’ve had great success keeping the CGM sensor on my leg for the full 10 days without a single peel in the adhesive. Another tip I’ve picked up along the way is to contact Dexcom and ask for their free “overlay patches”, which they produce and that work just like any medical adhesive that Pump Peelz or GrifGrips manufacture especially for Dexcom products.

I just want you to know...
Oh hey, it’s me! In my purple cast showing off the G6. Fun fact: I don’t own an Apple watch – the one I’m wearing here was provided to me to wear just for the G6 promotional materials.

 

Question: Is sensor insertion truly painless?

Answer: For me, G6 insertion has been pain-free approximately 85% of the time. It’s stung slightly a handful of times, but I’ve found that it only hurts when I choose a site that’s not particularly fatty. That’s why I generally stick with my abdomen – either side of my navel – or the back of my arms for G6 insertion.

I stand by this estimate – once in a while, I get a site that’s a little more sensitive and there’s a slight sting, but nothing like it used to be for the G4 or G5. And now that I’ve added my thighs as sites into the mix, I’ve got more site rotation going on, which can help.

Question: Is the G6 really that much more accurate compared to the G5, or any other CGM on the market?

Answer: Yes and no. That may not be a very satisfactory answer, but I’ll explain why that’s my belief. Overall, the G6 seems to be more accurate for me than the previous Dexcom CGM models I’ve worn. Are the number always on point compared to what appears on my meter? No. Do I wear the Dexcom CGM to have an accurate picture of what my exact number is at a given moment in time? Kind of, but I also know that this isn’t totally realistic. After all, users of the Dexcom CGMs know that it measures blood sugar levels in five-minute intervals. It can’t give me a clearer picture of what my blood sugar changes are minute-to-minute. So with that in mind, I find that the G6 is really excellent for monitoring trends – seeing how rapidly my blood sugar is falling or rising, or seeing how it changes gradually over time. The patterns are more important to me than the precise numbers; at least, that’s how I feel in my current stage of diabetes management.

I can’t really speak to other CGMs on the market, such as the Freestyle Libre or Medtronic’s CGM. But what I can say is that I’ve heard less-than-stellar reviews about both. It’s important to remember, though, that they’re not meant to be the exact same as the Dexcom CGM. The Libre itself isn’t really continuous and can’t provide users with information until they chose to wave the receiver over the sensor. And as far as I’m aware, the Medtronic CGM communicates directly with Medtronic pumps, and I’m not sure how seamlessly the systems work together.

Bear in mind that when it all comes down to it, I’m answering these questions with my experience, and my experience alone, in mind. Dexcom is and will always be the number one resource to go to with any questions regarding their CGM devices. But hopefully, the information I’ve shared here will at least help someone who is curious about the G6 feel more motivated to seek additional information. I stand by the fact that it has revolutionized my own diabetes care and management, and though it’s far from being flawless, it’s still an invaluable tool to have incorporated into my daily routine.

I still have not tried any CGM model out on the market except for Dexcom CGMs. To this day, it’s what I know and what I’m most comfortable with, so I don’t anticipate that changing any time soon (though it’d be kind of cool to try another and compare it to my G6). The one thing that has changed is that I rely on my G6 readings a lot more heavily these days. I use a blood sugar meter to check my blood sugar only once or twice a day now, whereas a year and a half ago, I was using it at least four times a day. I’ve put greater trust into my G6, but I do remain cautious against the technology and always check with my meter when I’m not fully believing my G6’s readings.

Why I Decided to Become a Digital Advocate for T1International

When I started Hugging the Cactus, I knew I wanted to do more with it than just use it as a platform to share my diabetes story.

I also wanted to make change.

I wanted to do more for my diabetes community.

I wanted to become the best advocate that I could possibly be.

But for a long time, I was stuck on how exactly to go about doing that.

During this time in quarantine, I’ve been able to spend more time thinking and researching ways that I could get more involved.

And that’s what lead me to T1International.

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#insulin4all means FOR ALL.

As I mentioned in a blog post earlier this month, I’ve sort of known about T1International for a long time now. I knew that they were the organization behind the well-known hashtag #insulin4all, but I was curious to learn more about them and their mission.

As I discovered, T1International works to support local communities by giving them the tools they need to stand up for their rights so that access to insulin and diabetes supplies becomes a reality for all. They have a plethora of materials and information on their website that helps those who are interested become well-versed in this issues surrounding insulin and diabetes supply accessibility. In addition, the T1International team keeps site visitors up-to-date with their blog that contains articles on everything from global stories to legislation explanations.

It wasn’t long before I realized I wanted to work with T1International. So I reached out to their team and applied to become a digital advocate, and less than one week later, I completed my orientation. It’s official: I’m a proud T1International digital advocate.

This is meaningful to me because now I feel more empowered to advocate about the issues that matter, such as the #insulin4all movement. This movement is so important because access to insulin, no matter who you are, where you’re from, or what type of diabetes you have, is critical to the health of all individuals who rely on insulin to live.

Before I dive more into the insulin crisis, let me first acknowledge that I am extraordinarily lucky and privileged: Insulin affordability has never been a personal issue for me. Sure, I’ve had to pay way more out of pocket than I’d like to in order to cover the cost of insulin, but I’ve never had to make the impossible choice between paying for a month’s supply of insulin OR paying for monthly rent.

Many people have had to make that sort of choice, though. And that’s simply not okay.

Whether you’re familiar or unfamiliar with the current insulin crisis, consider the following facts (provided by T1International):

  • Since the 1990s, the cost of insulin has increased over 1,200%, yet the cost of production for a vial of analog insulin is between $3.69 and $6.16.
  • Spending by patients with type 1 diabetes on insulin nearly doubled from 2012 to 2016, increasing from $2900 to $5700.
  • A study of rising drug prices over the decade ending in 2018 found that list prices of insulins increased by 262%, with net prices increasing by 51%.
  • One of every four patients with type 1 diabetes has had to ration their insulin due to cost. Many have died.

These statistics are more than alarming. They’re downright disgraceful, unjust, and have forced patients to resort to drastic measures to stay alive.

Change needs to happen.

This is why I’m humbled, fired up, outraged, and beyond ready to join the T1International digital advocates team and become one more voice who helps to make the issues regarding insulin access and affordability heard.

My Favorite Blood Sugar

I have a favorite blood sugar reading. Can you guess what it is?

…Probably not. So I’ll just tell you. My favorite blood sugar reading of all time is…

115 mg/dL.

My Favorite Blood Sugar
Apparently the last time (on record) that my blood sugar was my favorite number was on April 25th – I’m sure I had an especially good day because of that.

I can justify my favoritism for this seemingly random reading, too. For starters, 115 literally contains my favorite number ever, 5. (I think it’s my favorite number because I was born in the fifth month, May, and it’s so easy to count in multiples of 5.)

115 also represents “perfect” stability to me. I’m guaranteed not to feel the shakiness of a low or the grumpiness of a high at this level. At 115, I can most likely even have a small snack (no more than 15 carbs, but still) and not have to take a single drop of insulin for it (given that I’m exercising for at least 15 minutes post-snack-consumption, of course).

Hmm…there’s definitely a pattern going on there with that trifecta of fifteens, but I digress.

A blood sugar of 115 makes me feel…invincible. Almost like I’m the proud owner of a functioning pancreas.