Category: Diabetes Technology (DTech)

A Temporary Diabetes Cure

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I always envied people who experienced a diabetes “honeymoon” period. I used to think, how nice it must be to have some extra time to prepare for fulltime life with diabetes and not quite rely on insulin injections right off the bat! I also always assumed that, after 25 years living with diabetes, that the honeymoon phase had absolutely skipped over me, and I was positive I’d never get to experience it.

Turns out, my diabetes – that saucy little minx – likes to keep me on my toes as it recently surprised me with an abrupt 48-hour window of time in which it seemed like my diabetes was cured.

That’s the only way I can describe what transpired. It was the strangest thing. One day, I woke up, ate breakfast, and took insulin for it – just as I always do. Except instead of my blood sugar spiking or even leveling out after eating, it started to drop, which was strange because I ate a fairly typical meal that morning. At the time, I thought nothing of it and just ate some extra carbs before my blood sugar went too low.

No big deal, right? But this phenomenon happened again, following both my lunch and dinner. It was especially inconvenient in the evening, as I had a volleyball game and wanted my number to be up so I could play. I had some fruit snacks before the game to keep my levels up, but was surprised when even after that, I was dropping by the tail end of our third and final match. I remember being out on the court, trying to track the ball as my team bumped it back and forth over the net with the other team, knowing full well that my blood sugar was going low but feeling determined to stay in the game until it was over. The moment the final whistle blew, I ran to grab even more fruit snacks, and felt both annoyed and confused by the whole situation.

The following day, I decided I wasn’t going to mess around anymore. I wanted to cut my mealtime insulin doses in half to see if that helped me at all. It was a solid idea, but it didn’t prove to do much to help as I again dropped after breakfast and lunch. Okay, so clearly that course of action wasn’t enough. Maybe I could try switching from automated mode to manual on my Omnipod 5 PDM and put myself fully in control, rather than leaving it up to technology. I set a temp basal decrease to ensure I was getting very little basal insulin, and resolved to enjoy my pizza dinner that evening with friends.

Of course, pizza is notoriously difficult to bolus for, so I knew I’d have to do even more extra work in order to prevent my blood sugar from dipping. So not only did I take half the amount of insulin than normal, but I also did an extended bolus so that I wouldn’t get it all upfront. I ate two fairly large slices of pizza and also had a generous serving of chips that I technically didn’t include in my bolus calculations. So imagine my bewilderment when, 2-3 hours post-pizza, I was still going low. I poured myself a glass of regular soda, and it became my companion for the remainder of the evening. I’d take sips as I saw my graph report blood sugars that never went higher than 110, but fluctuated for the most part between 60 and 90.

It was wild, and I was actually getting pretty worried about the whole situation. I couldn’t make sense of it. I ran through all the variables that could’ve caused this to happen – was I wearing my pod in a strange site? Was it because of my period? Could it be due to my activity levels or changes in the weather? I weighed so many possibilities in my mind and came up with nothing definitive, so I went to my next best resource for input…the diabetes online community.

I asked around for input and was – as always – so grateful to the folks who reached out and served as thought partners with me. Based on what I learned, the most likely culprit is hormonal changes. In fact, perhaps it was a bit of a birthday gift from my diabetes as I ushered in a new age/phase in life. It’s still totally bizarre that it happened, but a friend reassured me of her own experiences with the same temporary phenomenon as she’s experienced menopausal shifts. So, maybe…just maybe this was the explanation I was looking for, and perhaps the whole thing happened to signify the start of my upcoming cycle.

I won’t ever know for certain if that was indeed the cause of my temporary reprieve from diabetes, but at least I can find a little comfort in knowing that I got through it (as my blood sugars and insulin needs bounced back with a vengeance the following day) and that I had the support and feedback from friends and strangers alike the whole time.

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CGM or Security Blanket?

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So…remember all the times on this blog that I wrote about how important it is, as a person with diabetes, to be prepared at all times? And how it’s vital to have a back-up in case something unexpected happens with technology?

Well, apparently I don’t take my own advice. I mean, I usually do, but once in a blue moon, I am forgetful. Or negligent. In this particular scenario, I was both, because I simply didn’t pay attention to the fact that my CGM sensor was due for a change…and I was stuck at my workplace office, roughly 45 minutes from home, without my meter or a backup sensor in my bag. So when my CGM sensor expired at 1:48 in the afternoon, I realized that I wouldn’t have a means of checking my blood sugar until I returned home for the day. And I was a bit freaked out about that.

My biggest concern was that my blood sugar levels would run high and I wouldn’t know for certain or be able to do anything about it. I’d eaten more carbohydrates at lunchtime than usual, and had low confidence that I’d guessed the carb count accurately.

Instead of losing my cool or deciding to head home early, though, I impressed myself by choosing to ride it out. I felt sure that I’d be able to pick up my body’s signals if my blood sugar began to run low (which is definitely scarier than it running high for too long, anyways), and if it were high? Well, then, I’d just have to cut my losses and correct for it as soon as I got home. It’s never fun to have high blood sugar when it can be so easily fixed with an insulin dose, but given my options in this particular scenario I decided that I’d make peace with it, should that end up being my outcome.

It was a long 3ish hours, flying blind without my security blanket I mean, CGM, but I made it through and checked my blood sugar with my meter the moment I arrived home. And guess what? All that worrying about being high was for nothing because I was sitting pretty at 82 – a stellar blood sugar level in ordinary circumstances, but one that felt especially victorious after this less-than-ideal situation I got myself into.

The whole experience opened my eyes to the fact that my CGM is more than just a piece of diabetes technology to me, it’s a security blanket. It makes me feel that much more confident in making the majority of my diabetes-related decisions on a daily basis. And while it’s great that I have my CGM’s data available to me most of the time, it’s also an indication that maybe I could stand to be a little less reliant on it and trust myself and my own body a bit more. Maybe I could stand to check my graph 50% less than I do each day (believe me, I glance at it frequently, definitely more than I need to) to build a healthier boundary between me and my CGM. Or maybe I can do a better job at keeping tabs on my back-up supplies so I don’t run into this again.

Or…maybe I can totally do both of those things to do a better job of becoming my own source of security when it comes to my diabetes. I like the sound of that.

Do We Take Medical Technology for Granted?

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This was originally published on Hugging the Cactus on December 4, 2019. I’m sharing it again today because there have been many diabetes tech outages since then – and I’m certain there will be more in the future – but my question still remains: Do we take medical technology for granted? I ponder the answer to that below…

Alright, now that I’ve got THAT out of the way…

For the last several days, the DOC has been in a bit of a panic. And when I say “bit” I mean “a helluva lot”. That’s because the day after Thanksgiving, Dexcom Follow stopped working. This means that parents/caretakers who rely on the technology to monitor their child’s/loved one’s blood sugar levels were left in the dark. It sparked confusion, outrage, and downright fear, all of which only seemed to intensify over the weekend and into this week when the problem was only partially solved for most users.

Rather than coming together to support one another, the DOC swiftly divided into two camps: The first consisted of individuals who sought to gently remind others that this technology is still pretty new. It hasn’t even been around for two decades. That meant that for many years before then, people with diabetes were doing things the “old school” way, and getting by just fine. Doesn’t this mean that we should all be able to make it through unexpected technology blackouts, knowing that we have our blood sugar meters to fall back on?

The second camp was in a greater fury over the issue. This camp relied on the Dexcom G6 system because those within it simply didn’t know a life without the continuous glucose monitoring technology. For them, the outage was a bit like asking them to Google something without access to the Internet – it’s pretty much impossible, unless you’ve got an Encyclopedia handy. Oh, and it’s MUCH higher stakes, because people who don’t recognize symptoms of low or high blood sugar need this technology to work in order to stay on top of fluctuating blood sugar levels. Let’s not even get into how much is PAID for this expensive piece of medical equipment…one would argue that the high cost of supplies means that the technology should work at all times, no matter what.

If you’re like me, you can see that both of these groups have perfectly valid points. I’ve had diabetes long enough that I didn’t even use – and didn’t see the point in using – continuous glucose monitoring or insulin pumps until a few years ago. I took care of my diabetes the old fashioned way growing up: doing fingerstick checks multiple times per day, treating low blood sugars with 15 carbs then waiting 15 minutes, checking blood sugar levels about an hour after injecting insulin to make sure highs were coming down the way they should. This way of handling diabetes worked for me for a long, long time…throughout elementary, middle, and high school, right up to college.

Then I got a continuous glucose monitor (I believe it was the Dexcom G4) just before starting my freshman year of college. And I haven’t really been without a CGM device since then. It’s changed my life and helped me navigate adulthood with diabetes. Whenever I do experience periods of the technology not working the way it should, it’s infuriating because I feel like it’s not worth throwing away buckets of cash on it in those periods of inconsistency and inaccuracy.

But here’s what I’m wondering, as a result of this Great Dexcom G6 Outage of 2019…do we take this technology for granted?

Do we truly appreciate the times that it works the way it should?

Do we expect too much from something that, technologically speaking, still has a long way to go in terms of working perfectly?

Do we rely too heavily on continuous glucose monitors to provide us peace of mind when, in reality, they simply provide us with real-time updates of our blood sugar levels (i.e., it’s a stream of data)?

I don’t have answers to these questions. I can reflect on my own answers to them; furthermore, I can ponder how and why the DOC gets so divisive in these times where we should try to come together, listen to (and learn from) differing perspectives, and figure out what we can do to best support one another during trying times.

My Thoughts on the Discontinuation of the Omnipod Eros System

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Too soon.

Those were the first words that came to mind when I learned that the Omnipod Eros system – the one that comes with a bulkier, non-touchscreen PDM – was going to be discontinued at the end of this year. (You can get more information about this decision here.)

Now, you might be wondering why I’d have that reaction, especially considering I haven’t been on the Eros system in over two years. And when I am fully aware of the fact that the Omnipod Dash and 5 systems are out, available, and the latest/greatest offerings when it comes to pump therapy from Insulet.

The main reason why I think it’s too soon to nix the Eros system? It’s because of how it affects choice. By discontinuing it, this means there’s one less option on the market for people who are interested in Omnipod’s tubeless insulin delivery. Not so much in terms of the pod itself, as that design has largely remained unchanged as Insulet innovates products over time, but certainly regarding the PDM device.

It goes without saying that the Eros PDM is clunky, uglier, and overall out-of-date compared to it’s newer counterparts. The Eros PDM is a behemoth in size that relies on AAA batteries to keep it running and features chunky buttons that need to be firmly pressed in order to navigate from one screen to the next. Meanwhile, the Dash and 5 PDMs are sleek, touchscreen models that can be charged just like a cell phone. So I can’t deny that the Eros looks like it’s from the Stone Age when comparing it to the Dash and 5.

But this is actually favorable to some people. One thing that kept me from transitioning to an insulin pump for a long time was that I didn’t want to feel super attached to yet another physical piece of equipment I’d have to carry around; at that point in my life, I was already toting around my phone and separate CGM receiver (this was pre-Dexcom app days) everywhere I went. When I finally did start using the Omnipod Eros, it took time for me to get used to the PDM, but I came to appreciate it for its distinct heft, and could quickly and easily grab it from my bag without really having to look for it due to its size.

I liked my Eros PDM so much that I have more than one image of myself holding it up in my photo archives…

Now, I constantly get my PDM and cell phone mixed up – sometimes, I even go to text someone from my PDM, only to realize after I unlock it that I grabbed the wrong device. And I hate that I have another piece of tech that needs to be recharged so frequently. I monitor the battery life all the dang time, and have to plug my PDM in every few days to fully recharge it, whereas with the Eros all I had to do was swap out the batteries every 3 or so months. It doesn’t sound like that big of a deal, but I already have so much to monitor when it comes to my diabetes that I sometimes resent that I have to also keep an eye on the technology that’s supposed to help me simplify my management.

Moreover, a reason why the Eros PDM was so bulky was that it also doubled as a blood sugar meter. Admittedly, I scarcely ever utilized it as such, but it was always nice to know that I had the option of doing so if I wanted. Since the Dash and the 5 PDMs are essentially repurposed smartphones, the blood sugar meter function isn’t available on either, and I know this is probably a bummer to some people with diabetes who preferred using the PDM device as an all-in-one type of technology.

So while I get the decision to encourage more folks to upgrade to newer Omnipod systems, I’m also a little bummed for the individuals who were deliberately postponing that move, or not wanting to make it in the first place. I can totally relate to not feeling ready to make a diabetes tech change-up; after all, I waited almost 15 years of having diabetes before I even thought about trying an insulin pump. I benefited from being able to make that transition when I felt ready, and I just feel that it’s a shame that others won’t be able to do the same due to the pending discontinuation of the Omnipod Eros.

Girl, Interrupted (by Diabetes)

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A packed conference room. A Dexcom alert due to a low blood sugar. A girl, interrupted as she tries to reconcile what her diabetes demands and what her professional responsibilities required her to do.

A girl, interrupted by diabetes.

Oh hey, I am that girl, and I found myself in this precise scenario when I attended in-office training for my job.

It was just after noon and I was rebounding from a high blood sugar that I’d dealt with earlier in the day. We were going to break for lunch at any moment, and it wasn’t like my blood sugar was tanking – it was holding steady around 65-70 mg/dL. But it was enough to disrupt my concentration on the work presentation and throw me off-guard.

It’d been quite some time – years, honestly – since I found myself dealing with the stress of a low blood sugar in a room filled with people, most of whom I didn’t know. Likely, it hadn’t occurred since I was at my last office job. But it didn’t really matter how long ago or when, precisely, it happened – all I could think about was, how the heck did I manage lows before in workplace meetings that I couldn’t easily excuse myself from?

It might sound like I was overcomplicating matters – I could just get up and excuse myself from the room while I found a snack to treat the low – but one shortcoming that’s followed me about my diabetes and my professional journey is that I like to keep all diabetes matters as low of a priority as possible during the workday. Of course, I take care of myself by making sure I eat regularly and keeping extra supplies on-hand, but I don’t always correct my blood sugar as quickly as I might normally when I’m somewhere else, such as home. I don’t know if it’s my determination to prove to my colleagues that diabetes doesn’t interfere with my workflow or some factor that gets in my way, but I know enough that I’m able to admit that it’s a slight issue for me that I ought to work on.

So when I began to feel the shakes of an oncoming low blood sugar, that was confirmed by a buzzing Dexcom, I found myself toying between two choices: 1) Either I could excuse myself from the conference room and grab a snack, or 2) I could power through, as there was likely 20 minutes or less remaining in the session. As I deliberated, anxiety slowly crept in as I started imagining nightmare scenarios in which I passed out in front of my colleagues. That’s when *ding* the lightbulb went off over my head: I remembered the hard candies I’d pocketed earlier in the day, which I’d intended to be a bit of a post-lunch treat but then realized they’d work great as a smaller-scale low treatment just when I needed it.

I popped one in my mouth and spent the next 15 minutes doing my best to immerse myself back into the training, while also taking a moment to acknowledge that I’d made a mountain out of a molehill in this situation. I don’t need to feel so self-conscious when minor diabetes-related issues happen, whether I’m at work or anywhere else. The most important thing is that I take action in a timely manner, so I can prevent more severely disruptive scenarios from happening.

The Worst Time to Change a CGM Sensor or Pod

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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.

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

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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)

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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

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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.

It’s More Than a PDM

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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.