Which Blood Sugar Meter I’m Using These Days (and Why)

Over the summer, I wrote about how not one, but two new blood sugar meters (or glucometers, or bg meter…whatever you wanna call it) fell into my lap.

The first one – the Livongo meter – was made available to me through a recently launched company benefit from my employer for people with diabetes. A starter kit, including a meter, strips, lancets, and a carrying case, was mailed to me and I can actually order more strips as needed quickly and easily using a feature of the meter.

I obtained the second meter from my endocrinologist…but it was kind of by mistake. I was promised the latest and greatest Verio meter, the Verio Reflect, but the office set aside the Verio Flex for me. It was still technically an upgrade from my Verio IQ (a meter that isn’t even distributed anymore), but lacking the flash and flair of the Reflect.

So there you have it: I have the Livongo, the Flex, and the IQ. Which one do I actually use, though?

The answer might surprise you based on my review.

I’ve been sticking with the Livongo meter, even though there are times when I question its accuracy.

I’ve liked using my Livongo as my #1 meter…a nice change of pace compared to my old Verio IQ. And I feel very fortunate to have choice when I know so many people don’t.

To combat that, I do a lot of comparing and contrasting with whatever my Dexcom is telling me…and I rely heavily on my physical symptoms when I’m low or high to help increase my confidence in what my devices are reporting.

In addition, my decision to use my Livongo as my main meter (and keep the IQ and Flex as back-ups, of course) was pretty easy to make in the long run because any test strips that I’ll need for it in the future will be provided by my company without any additional cost to me. I’m sorry (not really sorry), but if I can get ANY diabetes supply for FREE, then I’m going to jump on it…even if I’m not 100% in love with its functionality.

Accuracy is definitely the number one factor to me when considering using ANY diabetes device, but I’m also the type of person who is a little wary of any new technology. I will probably always doubt whatever it tells me to some extent. I’ve only really called into question the accuracy of my Livongo meter a handful of times, which isn’t a bad track record. And that’s basically my main gripe with the meter as a whole…otherwise, I love its design, style, ease of use, etc.

But I especially love that I didn’t have to pay a cent for it.

PDM System Error: What It Is and What to Do When It Happens

I crack open the slot on the back of my PDM where two AAA batteries are nestled. I smack them out from their slots, insert two fresh ones, and replace the cover. I wait for the system to power back on and am greeted with a high-pitched beeping sound soon after it’s reactivated…

…and become simultaneously annoyed, confused, and a bit panicked when I see a “system error” message displaying on the screen.

I follow the steps that flash on its display, instructing me to reset the date and time. Once I take care of that, my pod immediately deactivates, aggravating me further. I assemble all the supplies I need to activate a new pod, and once I have it on, I receive a message that I won’t be able to use the bolus calculation function on my PDM for 3-4 hours.

The whole incident was majorly inconvenient, but such is life with diabetes…

Anyways, if you’re like me, you’re probably wondering what exactly happened, and why it triggered my pod to fail.

Error messages on diabetes technology are never something I’ll be glad to see, but they do happen.

Fortunately, I can explain it!

I’ve experienced this phenomenon before – it happens when the internal battery within the PDM (not the AAA batteries) has a problem and stops working the way it should. It causes the system to get confused when new AAA batteries are inserted (because the system shuts off and turns back on) and it doesn’t remember the date or time. Because of that, it can’t identify when the current pod was activated, so it immediately triggers it to stop working so new one can be applied.

It’s obnoxious as heck because it’s a total unpredictable phenomenon, but it is what it is. It can be dealt with in a matter of a few hours, and the best part is that Insulet can be contacted so they can be made aware of the issue and overnight a new PDM – which is what they did for me. The day after this PDM problem occurred, I gave them a call, and within 10 minutes I was promised a new PDM that I would receive in about 24 hours.

So when a PDM system error happens again – not that I actually anticipate it to for a long time – I know the right course of action is to keep calm, follow the system’s instructions, and give Insulet a phone call. In other words? Rolls with the punches, because diabetes is good at directing them my way.

“Doesn’t Your Pump Do All the Work for You?”

The answer to the above question is a big, fat, resounding…

NO.

I’ve written blog posts in the past about questions I’m frequently asked about life with diabetes, but shockingly, I neglected to include this one…which is so surprising because it’s probably among the more frustrating questions.

Don’t get me wrong: Diabetes technology has come a loooooong way, particularly in the last couple of decades. There are options when it comes to insulin pumps and pens alike (that is, if the choices are covered by insurance…that’s another story for a different post). There are tubed, tubeless, touchscreen, CGM-integrated, and waterproof pumps out there. There’s even a couple with intelligent software that can kick in and predict low or high blood sugars. And there are smarter insulin pens available that far surpass the ones I used just 7ish years ago…some can track insulin intake and are bluetooth-enabled.

It sounds like our pumps should be equipped to do all the work for us…but the simple truth is that they can’t.

Our diabetes devices are far from perfect.

_Doesn't Your Pump Do All the Work for You__
No…these two pieces of plastic simply CANNOT do all the work for me. They actually rely on me quite heavily.

Failures happen.

Batteries drain.

Error messages pop up.

When it comes to dealing with diabetes, technology certainly helps us, but sometimes things can go so awry with it that it almost makes life even more frustrating.

Certainly, the reward outweighs the risk; after all, I don’t believe that many people would continue to use pumps, CGMs, etc. if they didn’t work for them the vast majority of the time. I know that I wouldn’t.

But there’s too many variables happening independently of these devices doing their jobs that it essentially guarantees imperfection.

Stress, miscalculated carbs, medication dose/timing/interactions, too much/too little sleep, expired insulin, temperature, exercise, menstruation, alcohol consumption, family and social pressures…these are JUST A FEW of the things that are known to impact blood sugar levels. Just a few!!! I can barely keep track of those factors, let alone how they each affect me…and to expect a machine to know how to do that is placing a little too much faith into something comprised of wires and chips.

My point is that I really wish that people living without diabetes didn’t make assumptions that our lives are easy because of these devices. They are easier, most of the time. But there’s that other portion of time in which a lot of spare mental energy is used on maintaining that technology and making sure it functions the way it should, which is far from easy.

The short answer to the question-as-a-title of this blog post is no, I (we) do all the work for my (our) insulin pump(s)…they’re smart and capable, but only with the input of the people handling them.

The Best Time to Do a Pod Change

Whether you’re new to using an insulin pump or a seasoned pro, you might be wondering if there’s a time of day that’s most ideal to do a pod/site change.

And I’m here to tell you…there isn’t a one-size-fits-all answer. (Sorry!)

Like many aspects of life with diabetes, the best time to do a pod change will be different for everyone.

However, I do feel pretty strongly about what works best for me, and I can explain why it does. Maybe that will help you or a T1D in your life decide what makes the most sense for your individual situation!

The best time to do a pod or an insulin pump site change will probably vary for most people with diabetes, just like so many other things.

In my opinion, the best time to change my pod is within the 3-hour window after I’ve eaten dinner. Since I typically eat at about 5:30/6 o’clock, this means that I like to change my pod no later than 9 o’clock at night (but preferably sometime around 8).

Here are the reasons why:

  • I can take my dinnertime bolus using a pod that I know for certain is acting the way it should.
  • That timeframe is early enough for me to verify that my new pod is acting the way it should before I go to bed.
  • Usually, I don’t eat much in the evenings after dinner, so even if my new pod isn’t working right, it’s not too big of a deal because it’s not like I’ll be bolusing for mealtime carbohydrates.
  • When I change my pod at other times of the day, it interrupts other aspects of my daily flow (e.g., my wake-up time or my work schedule).
  • There’s something to be said for ending my day with a fresh pod and incorporating the pod change into my bedtime wind-down routine.

Of course, I’ve had to change my pod at less-than-ideal times (I recently did a 6 A.M. pod change because I was deliberately wearing my pod for the maximum 80 hours and it was not my favorite way to start my day). Pods fail or get knocked off and I’ve learned to roll with the punches by having back-ups at all times.

But since I know my best time for a pod change, it’s really nice when I can stick with it…because any reliable aspect of life with diabetes is one that makes it ever-so-slightly more tolerable.

Throwback to My First Day With the OmniPod

Life is incredibly busy lately; as a result, I don’t have as much time as I’d like to write brand-new blog posts! But I thought this would be a fun throwback to publish today: the post I wrote for ASweetLife.org on January 21, 2015. It’s all about how I got started with my first (and only) insulin pump, the OmniPod. I’ve written so much about it here in the last few years and it recently occurred to me that I’ve never gone into much detail on how my first day with it went. Fortunately, I rediscovered this post, which does a great job at capturing all the emotions I experienced that day. Read on for more…

Today marks a new beginning for me. After seventeen years of taking insulin shots, I’ve made the move to a higher form of technology: the insulin pump! My pump of choice? The OmniPod, which appealed to me mainly because it is tubeless and my mother also uses it.

As the day went on, I experienced an array of emotions. I woke up feeling pumped (ha-ha, diabetic humor) because I realized I would be taking my last shot via insulin pen for the time being at breakfast. It was pretty anti-climatic, but a major moment for me nonetheless.

Some anxiety started settling in around midday. This was partly due to the fact I knew my visit with my diabetes educator would last roughly three hours in duration. I wasn’t exactly thrilled about having to spend a good chunk of my day off at the doctor’s office. I also had a few lingering questions. When would I take my first bolus? When would I be able to eat my next meal? Would it hurt when I inserted a new pod? I was driving myself nuts with my ceaseless stream of questions.

When it came time for me to actually leave for my appointment, I felt as ready as ever. I decided it would be best to just go with the flow and be patient as I listened to everything my diabetes educator needed to say to me.

Turns out there are no cutesy cartoons of insulin pumps out there (go figure)…but this woman looks like she COULD be playing with a new pump (a huge, futuristic one, that is).

Much to my relief, the three hours flew by more rapidly than I thought they would. In that span of time, I learned not only the basics of my pump, but the finer points that I may not have necessarily understood or picked up on my own. And I was reassured when upon inserting my first pod, I learned that it’s painless – my Dexcom causes more of an unpleasant pinch than the OmniPod system.

By the time I left the office, I had three more follow-up appointments scheduled and a fully active pump stuck on my belly. I didn’t give it much more thought until dinnertime, where I tested (more diabetic humor!) its abilities. I was impressed with how simple the entire insulin delivery process was, and I liked that my PDM would beep periodically to inform me of the status of my bolus.

Post-dinner, though, brought some frustration. As I write, I am still higher than I would like to be. It could be due to anything, which makes it especially irritating. Maybe I miscalculated my carb intake, or maybe my basal rate or insulin-to-carb ratio needs tweaking. For now, all I can do is accept the fact that the beginning of this new regimen will bring lots of trial-and-error with it and monitor my blood sugars carefully – it means waking up a couple times during the night, but I know I just have to do it.

I am not looking forward to this start-up period, but I am hopeful for what it will bring and what I can learn from it. I do look forward to sharing my experiences along the way, so stay tuned for my next post about my transition!

5 Things I Hate About Pod Failures

I’ve had a slew of pod failures – three in the last two weeks.

What gives? I’m not exactly sure yet, but I’m hoping to get to the bottom of it. I sent my most recent failed pod to OmniPod/Insulet for analysis, and my suspicions are telling me that I have a bad batch of pods in my arsenal.

While I wait to hear back, I decided to write a blog post listing the five things I hate the most about pod failures as a form of catharsis…

1 – How suddenly and randomly they occur. Pods don’t give an eff as to whether or not they fail at an inconvenient time. In the middle of a conference call? Fails can happen. Sleeping? Fails can happen. On a date? Fails can happen. Just sitting there minding your own damn business? Yes, still, fails can happen. The unpredictability of pod failures makes them doubly obnoxious and loathsome.

2 – That wretched, unrelenting BEEEEEEEEEEEEEEEEEEEEEEP. Crying babies, barking dogs, ambulance sirens – I’d much prefer any of those other sounds over the high-pitched scream of a failed pod. I get why it’s necessary – how else are you supposed to know that a pod is no longer functioning – but it makes my ears want to bleed. Plus, you’ve got no choice but to silence the pod by sticking a paperclip/toothpick/other equally skinny object into that teensy-weensy crevice in the corner of the device! Let’s be real here, who has a paperclip just…available like that at all times in the event of a pod failure? It’s no wonder I chose to silence my most recent screeching pod by taking a hammer to it (note to anyone else who chooses to use this method: DON’T DO IT INDOORS, go outside and smash it on the pavement or in your garage…and maybe wear something to protect your eyes, just in case).

I smashed this screaming pod with a hammer and let me tell you, it felt great to release my frustration that way!

3 – The perfectly good insulin that gets wasted. When I deal with a pod failure, I can sometimes salvage the remaining insulin left within by inserting the syringe from the brand-new replacement pod into the insulin reservoir and sucking it out (literally the opposite of adding insulin into the reservoir for a routine pod change). But it isn’t always possible to rescue the insulin due to time constraints, amount left, and so forth. So it’s extra painful to just toss the failed pod away knowing there’s insulin left inside it that I just won’t be able to use.

4 – You don’t always find out why it happened in the first place. I am a naturally inquisitive person who is always asking “why”. So when a pod fails, I want to know what went wrong. Unfortunately for me, I don’t always get an answer. OmniPod/Insulet customer service representatives might be able to tell me why based on the reference code I provide them when a pod fails – when that reference code is found in their database, the answer might be that static electricity caused it to fail, or that when the pod was performing its routine and automatic safety checks, the pod itself determined it could no longer be used. But there have been plenty of other times that my reference code didn’t signify anything, leaving me permanently clueless as to what happened to make the pod fail. SO FRUSTRATING!

5 – You have to call customer support in order to get a replacement. As someone who has customer support experience, I dread these sort of calls. It’s just a giant pain in the neck to have to go through everything about your experience with a failed pod, such as how long I was wearing it for, what brand of insulin I use, where the pod was located, the lot, sequence, and reference code numbers…the list of questions go on and on. The silver lining here is that I’ve almost always had a very positive experience when calling OmniPod/Insulet to report a pod failure. My issue is usually documented in 10 minutes or less, and I’ve never had a problem getting a replacement, which shows is indicative of superior customer service.

But…is it so much to ask for the dang thing to simply work the way it’s supposed to 100% of the time?!

Is the Livongo Blood Sugar Meter Accurate?

It occurred to me the other day that even though I wrote a couple of blog posts and even made a video about it, I still haven’t addressed one major component of my new Livongo blood sugar meter: its accuracy.

How does it stack up to my Verio meter? More importantly, do I think it’s accurate?

Well…the answer isn’t cut-and-dry because I think it can be accurate…as long as my blood sugar isn’t above 200.

How did I arrive at this conclusion?

I conducted a little experiment.

Bear in mind here, I’m no expert in experimental design, so I established a simple setup for this. During the period of approximately two weeks, whenever I checked my blood sugar, I used the same drop of blood on test strips for two different meters: my Livongo and my Verio.

And the results were interesting, to say the least.

Whenever I was about 80-180, my results from the Livongo meter and the Verio meter were within about 10 points from one another. One instance, I was 86 on the Livongo and 92 on the Verio. Another time, I was 105 on the Verio and 113 on the Livongo. The meters never reported the exact same number at any point during my experiment, but I was happy whenever they showed similar results.

Things got dicey, though, any time I entered the hyperglycemic range.

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That 163 and 165 show how at times, the two meters were in agreement with one another…but then there’s that 231 and 262. Those are just a little too different for my liking.

It was weird and I can’t explain it, but the Livongo would report that I was anywhere from 20-50 points higher than what was on my Verio at a given point in time when my levels were 200+. This really surprised me, because I’d suspected that my Verio skewed a little higher compared to most other meters, so I never thought that the Livongo would prove me wrong about that. At times, it was truly maddening: On one occasion, the Livongo said I was 251 and my Verio said I was 204. That’s the difference of at least 1-2 units of insulin for me in order to correct that high! Even more frustratingly, because I didn’t trust the result from either machine, I checked my blood sugar again immediately and the Verio said 242, while the Livongo said 228.

WTF?!

That particular example was extremely confusing because I didn’t know which piece of technology to trust. And that’s the big thing for me: I need to know that I can depend on whichever blood sugar meter I’m using to deliver accurate results.

So again, remember that I’m no good with numbers, and that this is simply an estimation…but if I had to guess how many times the Livongo agreed with the Verio, I’d say it was no more than 7 out of 10 times. And I’m super bummed about that, because I’d genuinely hoped that I could trust my Livongo meter and use it full-time whenever I was taking a break from my CGM. Given the fact that it seems to be accurate when my blood sugar is in range, though, I suppose I could use that as motivation to work harder to prevent hyperglycemic readings…but I’m not perfect and I know that they will still happen from time to time. And I deserve a piece of technology that will accurately report them to me so I can make the best possible treatment decisions.

In theory, I still like the Livongo: It has a great design and some of its features (e.g., test strip reordering) are totally unique. But in practice? It leaves a bit to be desired.

DASHed Hopes

It’s funny how much I’ve changed regarding diabetes and technology in the last decade.

I grew up not wanting to try the latest and greatest devices. I had zero interest in an insulin pump and was very set in my ways of doing multiple daily injections and finger stick pokes.

My (semi-forced) introduction to CGM technology when I was in my teens, though, changed everything for me. And I haven’t looked back since then. Actually, if anything, I’ve become more curious and excited about new technologies because they symbolize greater freedom from the heavy burden of diabetes.

So imagine how PUMPed (hehehe, diabetes humor) to hear about the redesigned OmniPod insulin management system!

This next iteration of OmniPod is known as the DASH system and it’s freaking cool. The clunky PDM has been upgraded to a sleek, touchscreen format and it’s rechargeable (no more AAA batteries). Plus, it comes with a whole host of upgrades and features that make the first generation of OmniPod look totally outdated.

Naturally, I wanted to give the DASH system a SHOT (LOL look at me, I’m on a roll with the puns).

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I took this image from the Insulet/OmniPod website so you guys could see how awesome the DASH system looks!

So I called Insulet and asked whether my insurance would cover the new PDM and pods, and how much everything might cost me. I learned that the major difference between how I receive pods now and how I’d receive the new DASH pods (because the DASH pods use Bluetooth, I can’t use my old radio-frequency-enabled pods with the DASH system) is that instead of getting pods directly from Insulet, I’d actually receive them through my mail-order prescription service (Express Scripts). That was fine by me – I get the pods in the mail anyway – but I wanted to know how it’d work in case a DASH pod fails on me. I was reassured by the representative that I’d still call Insulet to receive a replacement, just like I do now.

Okay, good information to know. But I really wanted to know about pricing. So I was connected with an Express Scripts representative, who informed me that the cost for a 3-month supply of DASH pods would be about $50 more than I pay now for my current pods.

I did the math. That’s around $200 more each year that I’d have to pay for my pods. That might not seem like a lot of money, but I pay right around that amount for a 3-month supply of insulin. Hypothetically, let’s say that I become financially strapped in the future, and I have to make the choice between paying for insulin or paying for my pods – when it comes down to it, obviously I’d choose insulin – but I shouldn’t have to make that choice.

So it looks like my hopes to go onto the OmniPod DASH are, well, DASHed (sorry, last bad pun, I swear) for now. I’m a little disappointed, but I’ll keep my fingers crossed that prices are lowered for DASH pods in the near future so I can take advantage of a very nicely designed, high-tech insulin pump system.

 

Can Certain Sites Trigger More Insulin Pump Failures?

Insulin pump sites have been a hot topic for me lately.

Not only did I share that I’m in the process of experimenting with some new (intimidating) sites, but I’m also contemplating the efficacy of all of my current sites.

My site lineup (as of this writing) includes the abdomen, upper arms, lower back, and thighs. And I’ve noticed an unusual pattern emerging with one of these sites that I know for a fact isn’t happening just to me – it’s happened to my mom, too…

…and that pattern is a series of failures with sites on the upper arms.

I can’t offer any explanation for it other than it’s definitely been a “thing” for my mom and I these last few weeks. It started happening to her first. I think she had 3 or 4 pod failures throughout August, and it only happened to pods that she was wearing on her upper arms. At first, I was skeptical of this and assumed it was maybe a bad batch or a total coincidence.

But then it happened to me, twice in a row.

On both occasions, I’d been sitting there, minding my own business (well, the first time, I was a passenger in a car and the second time, I was leading a virtual meeting with a couple dozen people on the call…the latter was far more disruptive).

Can Certain Sites Trigger More Insulin Pump Failures_
Here I am, holding up the second offending pod, right after I wrapped up the call during which it alarmed. Clearly, I was not amused.

My pods hadn’t been delivering a bolus.

I didn’t bump up or come into contact with the pods in any manner whatsoever.

My pods weren’t due to expire for another 12ish and 48ish hours, respectively.

There was no blood at the pod sites.

The cannulas on both pods weren’t kinked.

Static electricity wasn’t a factor.

But what these pods did have in common was that they were on my upper arms – one on the right, one on the left.

It’s straight-up bizarre, and when I called Insulet/OmniPod to report the second instance, I made sure they noted in their records that this phenomenon has occurred not just for me, but also for my mom. The representative didn’t say whether other people have been calling in with this issue, but it’s definitely weird that it’s happened more than once to both my mom and to me.

So while I can’t say for certain – at this time, anyways – whether particular sites result in more pod failures than others, I can say that I won’t be wearing a pod on my upper arm any time soon…and I’m going to be on the lookout for similar stories from other OmniPod users in the DOC. After all, our ingenious community can be even better than the pump manufacturers themselves when it comes to troubleshooting, so I’m hopeful that I can get to the bottom of this before long. I like my upper arm as a site because my insulin absorption is great there, but I’m not willing to use it again until I know I won’t experience another pod failure in the foreseeable future.

When it Comes to Dexcom Alarms…Never Assume

I may have had diabetes for more than three-quarters of my life, but that doesn’t mean that I don’t make silly mistakes with it from time to time.

But I must admit, I still surprise myself on the occasions that I make a slip-up that’s incredibly stupid…and incredibly avoidable.

When it Comes to Dexcom Alarms...Never Assume
In life with diabetes (and in general), mistakes are bound to happen…

For example, one morning my Dexcom started alarming, and I thought that I knew exactly why it was sounding off: It sounded like the signature triple buzz of a high alert, so I did what anyone else would do when it’s very early in the morning and not quite time to wake up yet…I ignored it and fell back asleep.

But true to typical Dexcom alarm nature, my sleep was interrupted again by continued buzzing. Rather than pick up my phone to dismiss the alarm, though, I decided to bolus for a couple of units without ever verifying that I was, indeed, high.

Yikes. Can you say rookie mistake?

Fortunately for me, I really did have to get up and start my day within a couple of hours of taking that bolus. Thank goodness I did, because when I got up, I immediately glanced at my Dexcom and was taken aback to see that my blood sugar had not ticked up past my high threshold in the last several hours…it had actually lost reception completely.

Ahh…so that’s what it was trying to tell me. Oops.

Furthermore, my blood sugar was inching below my low threshold – the two units I’d carelessly taken had kicked in, and all I could feel in that moment was relief that I hadn’t taken more insulin.

This story could’ve had a very different ending. I’m still kind of in disbelief that I didn’t just roll over to check my Dexcom and confirm the reason why it was alarming in the first place. I mean, that’s what I do any other time it goes off, regardless of the time of day. I suppose that I was just overly confident in what kind of alarm it was. Coupled with the fact that I was barely awake when this all went down, then it really isn’t all that crazy that this happened…but it doesn’t make me feel any less dumb.

Lesson learned. When it comes to Dexcom alarms, always check them, and never make assumptions.