I Forgot About Fingerstick Checks

It was just after 4:30 P.M. on a Thursday afternoon. I’d spent the last hour and a half at my work desk in my bedroom, checking email and dialing into a video conference call. I’d deliberately left my cell phone downstairs, wanting to resist the temptation to scroll idly through social media or check my blood sugar, which had been misbehaving most of the day.

At the conclusion of my virtual meeting, I lamented that my cell phone was downstairs. I wanted to know what my blood sugar was doing (especially if it was high so I could get some insulin pumping), but I didn’t want to walk that oh-so long distance down the stairs to retrieve it.

I sighed, resigning myself to the fact that I wouldn’t be able to check my blood sugar any time soon.

Then…I remembered.

I have a blood sugar meter mere feet away from me.

I could do a fingerstick check and actually know my blood sugar! I wouldn’t have to wait for my workday to end in order to check it, after all!

I still can’t believe that I momentarily forgot that I could check my blood sugar by pricking my finger…

As I ambled over to my nightstand where my blood sugar meter is always perched, I chuckled to myself, marveling over how I could forget that this was an option readily available to me.

Of course, I had the option to not be a lazy Susan and walk downstairs to get my phone, but that’s not the point! (Plus, I was trying to give myself a much-needed break from it!)

It just struck me as funny – I used blood sugar meters for two decades of my life. And bear in mind here, I haven’t even been alive for a full three decades yet, so blood sugar meters are just something I’ve grown up with. How could I forget about them? Have I really become so reliant on the 24/7 reporting from my Dexcom that I’ve shunted aside my only other device that can tell me what my blood sugars are?

I think that this incident indicates that I have. And that scares me a bit.

When I first became a Dexcom user in my late teenage years, I was told that my CGM wasn’t a replacement for fingerstick checks. So up until 3 years ago (when the Dexcom G6 came out), I tested my blood sugar with my meter at least 3-4 times per day, sometimes even more.

But then the Dexcom G6 came out, and the exciting news that the technology was so advanced that it meant that people with diabetes wouldn’t have to do fingerstick checks. Gone were the days of making diabetes treatment decisions only with confirmatory fingersticks or calibration. This was huge, but I was so untrusting of the technology for the first year or so that I continued on with regular fingerstick checks…

…Until one day I just kinda stopped. My multiple-times-per-day checks turned into maybe once or twice a day, then once or twice a week, and now…really, just once or twice a month. And now I’m facing the reality that I don’t exactly feel that this decision suits me because I am the type of person who craves as much data as possible so I can make the best-informed diabetes choices for myself.

So forgetting about fingerstick checks may just be my remembering again to do them. Because when I did check my level and saw that 140 mg/dL flash up on the screen, I felt reassured and thankful for this data point on my blood sugar graph. It was nice to see this number alone, without the reminder of the yucky numbers I experienced earlier in the day…

And best of all…I didn’t have to go downstairs in order to get this snippet of information.

Hello, Highs: Pooled Insulin Under my Pod Leads to Elevated BG

Have you ever tried troubleshooting a problem so much that you start to feel insane, and then like magic, the solution to it becomes clear and you wonder why you hadn’t tried it earlier?

This was the case with me and the mysterious high blood sugars that plagued me for two and a half days.

Based on this image, can you tell what was causing my blood sugar to be stubbornly high?

Once I started noticing a pattern of high blood sugars that got worse every time I ate food, I started doing everything else except changing my pod. I tried taking insulin for double the amount of carbs that I was actually eating, I ran a 95% temp basal increase for 8 out of 24 hours in the day, I cut carbs altogether and ate only 0 carb foods, I skipped meals altogether, and I even tried marching around the house for 15-minute intervals to try to get my insulin pumping through my system faster.

And nothing worked. I was able to get my blood sugar no lower than 180, but for most of that 60-hour window of time, I spent a good chunk of it in the mid-to-upper 200s.

Finally, on the day that my pod was due for a change, I decided that it must be the culprit behind my high blood sugars. When I removed the old pod, I knew immediately that something was wrong because the smell of insulin was so strong; plus, there was a large, damp spot on the pod’s adhesive, indicating that perhaps my insulin was pooling under my pod instead of entering my body.

It took 5-6 hours after I removed the leaky pod, but I finally did start to come back down to my normal levels, and was totally back on track the next day. It was a frustrating experience to endure, but a stark reminder of something that I’ve known in the back of my mind for years: that when I’m in doubt, I should change my pod.

How Long Do AAA Batteries Last in an OmniPod PDM?

How long do AAA batteries last in an OmniPod PDM?

The answer to this question has subtly haunted me for years.

My PDM is the only device in my diabetes management kit that actually runs on batteries. Everything else, such as my Dexcom receiver and my blood sugar meter, can be recharged, which is highly preferable over batteries. But until I make the transition to the OmniPod DASH system (which uses a rechargeable lithium battery in lieu of AAA batteries), I’m stuck with replacing the AAAs in my PDM whenever they drain.

But it was never overly clear to me…how do I actually know when the batteries are out of juice?

Just by looking at the battery display, you’d think that I’d need to swap out the AAAs A.S.A.P…but I discovered that isn’t the case.

There’s a battery icon on my PDM, of course, that shows roughly how much life my batteries have left in them. When new batteries are put into the PDM, it shows a fully charged battery. Some time after that, the battery icon is half full, and then after more time, it goes down to a tiny sliver to indicate the batteries are running low.

Ever since I became an OmniPod user, I always assumed that the batteries had to be replaced as soon as the display ran down to that itty bit of battery life. I just figured that was the signal. Plus, I didn’t want to run the risk of delivering a bolus or changing my pod only for my PDM to completely die halfway through, leaving me to figure out how much insulin I had left to deliver – or worse, with a pod not fully activated that I’d have to scrap.

For a long time, though, I’ve been wondering if I’ve been changing the batteries prematurely. Maybe they had more life past that little sliver. So I put my theory to the test: Last month, my PDM displayed the low battery icon. Instead of changing the batteries immediately, I decided to wait and see what would happen.

And I can report that my batteries did last much longer after that initial low battery icon appeared. In fact, they lasted an addition 7-8 pod changes (I lost track after the first handful). I was pleasantly surprised to discover that my PDM could make it almost an additional month past that first indication of a low battery! And even better, I learned that the system does give a warning that makes it crystal clear when the batteries should be changed: The battery icon goes from having a tiny bit of life left to a flashing display showing a completely empty battery. I forget what the exact message was on my PDM, but I also got a system notification telling me to change my batteries soon.

I wish I remembered exactly when I changed the batteries last, but if memory serves me correctly, then it was sometime in November. So the AAA batteries in my OmniPod PDM lasted roughly three months.

Not too shabby, and now I know exactly when I can expect to change my PDM batteries.

The Dexcom Site I’d Never Recommend Trying

I don’t usually regret trying new sites for my Dexcom and OmniPod.

But recently, I discovered the one area that I wish I hadn’t tried…and that is my forearm.

For a couple years now, I’ve seen forearm Dexcom sites all across social media. People lauded the location for how comfortable it is and the accurate readings it produces, so I figured, why not give it a shot? (LOL diabetes humor.)

Plus, I wanted to give my stomach and the backs of my arms a break. I put both pods and sensors in those locations and while I like them a lot, I’m wary of scar tissue building up.

So with little fanfare, I tried putting my Dexcom on my left forearm (my non-dominant arm). And I knew immediately after hitting the orange button to insert the sensor that it was a bad choice because it STUNG. It stung something fierce! I remember wincing the moment it pierced my skin, and fortunately, the pain did go away…but resurged with a vengeance about half the time I made any arm motions. It didn’t matter if I was flexing it up or down or twisting it to reach for something – any movement could trigger varying degrees of pain. Nothing incredibly intolerable, but enough to make this site uncomfortable.

My face says exactly how I feel about this site: It’s not a winner.

And this pain didn’t altogether disappear one day: I still felt stings 24 hours after I put the sensor on. Maybe I hit precisely the wrong spot (I noticed a very small amount of blood discoloring the white adhesive of the sensor), but I asked the diabetes online community and it seems that the general consensus is that this location sucks. The half-dozen or so people who messaged me said that either the pain was too much and they took the sensor off early, or they toughed it out for a full 10 days and never used the site again.

What’s more is that this site wasn’t as out-of-the-way as I wanted it to be. I roll up my sleeves dozens of times each day for different tasks, and each time I went to roll up my left sleeve, I had to go about it gingerly so I didn’t risk bumping into the site and prompting ripples of pain. This was straight-up annoying because my diabetes devices don’t usually inhibit my movements so much.

The one plus-side of trying the new site, and the only thing that motivated me to keep it on for the full 10 days, is that it was just as accurate as any other Dexcom site I’ve tried. My readings matched up pretty closely with how I felt and with what my blood sugar meter reported, so that was a saving grace. And I have to admit that even though I was worried that sleep would be impossible with the sensor in such a tender spot, it really didn’t interfere with my slumbers, which was a relief.

All in all, though, the accuracy wasn’t enough to convince me to want to keep forearm sites in my regular rotation. I’ll stick with abdomen and upper arm sites for now, with the occasional thigh site to further prevent scar tissue.

A New Pod in 5 Minutes Flat

I literally just got off the phone with OmniPod/Insulet as I’m writing this post.

I jumped on the computer right away because I was so impressed with the speediness of their customer support team.

Normally, I only call customer support to report the occasional pod failure. I had my first one of the year over the weekend, so I made some time during the week to give them a call and tell them about it.

I’m used to being hit with all kinds of questions when I call customer support: Where were you wearing the pod? What were you doing when it failed? How long were you wearing it for? What kind of insulin were you using in it? What’s your date of birth/shipping address/Social Security Number? (Okay, they don’t ask about that last one, but they need so much information from me that they might as well get that, too!)

This time, after I verified my shipping address, I was simply asked to rattle off the alarm code that triggered this pod failure, and state approximately how long I wore the pod.

That’s it.

I couldn’t believe how quick and easy it was to get a replacement pod.

Just a couple easy questions that I could answer straightaway because I had my PDM on hand (I always do when calling Insulet because 9 times out of 10, they’ll need information from it). The rep I spoke to on the phone just had one final question for me: Did I mind ground shipping for the replacement they were going to send to me, or did I need them to overnight it?

I let her know that standard shipping was just fine, and then I felt compelled to tell her that I was appreciative of her swift solution and professionalism. She thanked me and also clued me into the fact that Insulet’s worked hard to streamline the number and type of questions asked when customers call in, which made someone like me doubly happy.

I thanked her for her help again before hanging up the phone. Then I noticed: The length of our phone call was just under 5 minutes. It takes me a bit longer than that, on average, to apply a new pod.

In 5 minutes flat, a replacement pod was on its way to this satisfied customer. It’s nice to know that when pod failures happen – they do, and they will happen again – it’ll be much easier going forward to get them replaced.

Endless Email Threads and Telephone Tag with Dexcom

It started with the emails…then progressed to phone calls.

Voicemail messages were left and I tried calling back. No answer.

Emails were sent (yes, multiple) and still…no answer.

Am I describing a creepy, stalker-y movie plot OR my experience with Dexcom customer service???

I assure you that I did not look this calm and composed when reading my Dexcom emails or calling the Dexcom reps.

If you guessed the latter, then ding-ding-ding, you’re right! (Sorry if you’re disappointed it’s not the former, this blog post is most definitely not about to take a When a Stranger Calls type of turn.)

No fewer than five Dexcom representatives have tried to contact me in the last month and up until a few days ago, I had no freakin’ clue why.

Let’s go back to the emails: I got THREE that said something along the following lines:

We have a new update regarding your pending Dexcom order. We have attempted to reach you but were unsuccessful. Please call me or respond to this email…

I haven’t placed a Dexcom order since the year began because 1) I wasn’t eligible to order new supplies yet and 2) I have enough sensors and a brand-new transmitter that will tide me over for the next two months at least. So I really didn’t understand why my order was already pending and, more importantly, why the “new update” wasn’t just written out in the email.

So I responded to the first two emails that I received that were like this, and was annoyed when nobody ever replied. But then I got an email about a reimbursement that really sent me into a tailspin. What reimbursement?!

I called Dexcom myself and spoke to a real, actual human being who told me that the reason why Dexcom reps were reaching out is because they did my annual review of insurance benefits and determined that I was eligible to reorder my supplies. Oh! I explained to the rep that that made sense to me, and now I understood why they were trying to get in touch with me…but what was this reimbursement business?

Unfortunately, she couldn’t tell me and instead informed me that I’d have to call the Dexcom billing department. This irked me, but I accepted it and began to wonder whether maybe the email was simply another notification that I could go ahead and reorder my supplies. I decided that I wouldn’t give Dexcom a call back, making the assumption that they were done with me.

Boy oh boy, was I wrong!

One night, Dexcom called my cell phone, and then my parents’ home phone (they must have it stored in their records from when I lived there), and then EMAILED ME AGAIN saying that they have an update on my pending order. By this point in time, I was furious. I tried calling back the TWO DIFFERENT NUMBERS for TWO DIFFERENT REPS and one line never even rang, while the other one went straight to voicemail (I couldn’t even leave a message because the inbox was full). I vowed to call back Dexcom customer service the next day to get to the bottom of this, once and for all.

When I called, I explained the situation – how I’ve received a handful of phone calls and emails that I’ve tried to reply to but never got answers. I also detailed how I’d spoken with a company rep in the last week and I thought I made it clear to her that I take care of my own Dexcom ordering using their online system, and that I don’t need a rep to walk me through the process. It was a longer-than-it-should’ve-been phone call because I felt like the rep wasn’t really listening to me: She kept talking over me and couldn’t seem to grasp that I’m perfectly capable of handling reorders on my own. Finally, things got resolved in the end when she told me that she just emailed my account representative and informed him that I can handle my reorder in my own time, and that should he need to talk to me, please get in touch with me as soon as possible.

Listen, y’all – I love my Dexcom CGM. It’s one of the first diabetes devices that I wore and it revolutionized diabetes care for me. I also appreciate Dexcom employees for their hard work, and as someone who used to do customer service over the phone, I seriously value the amount of time and energy that it takes to deal with dozens of customers each week and try to walk each of them through a satisfying solution. So the point of this blog post is to not dis a company that I like, but merely to point out that there are clearly some flaws in the customer communication system.

I mean…going back to my earlier point, if Dexcom knew what the “update” was, why didn’t they specify it in the email or the voicemail message?

I’m not sure I’ll ever know the answer to that, but I do know this and I’m making a mental note of it now: Remember that next January, an insurance benefits check will be completed by Dexcom and I’ll probably be contacted about it – even if they don’t tell me that’s why they’re trying to get in touch, at least I’ll now have a sense as to what it’s about the next time around.

How to Make Medical Adhesive for CGMs and Pumps Last Longer

Something that all people with diabetes that I know – myself included – struggle with from time to time is the adhesive that keeps our diabetes devices stuck to our bodies.

Real talk? Both the adhesives for my pods and my Dexcom sensors can be lackluster. About half the time, the adhesives that secure them to my body begin to peel around the edges when I’m only partway through the wear time of both devices. And another (much smaller, though far more infuriating) part of the time, the adhesives lose their stickiness entirely, causing the device to fall off my body.

When the adhesive is the reason why a sensor or a pod doesn’t last the full 10 and 7 days, respectively, it’s practically like experiencing a slap in the face because at least a technology error or failure feels more out of my control…the adhesive, though, feels like something that should never be a real issue, and I can’t help but blame myself for not making a pod or sensor more secure when the glue completely fades.

On the bright side, my experience with less-than-sticky pods and sensors forced me to think of ways to get them to last their full lifecycles on my body. Here’s how I make them last as long as possible:

Protective barrier wipes: I use these wipes each time I do a pod change. When my new pod is priming, I wipe whichever site I’m about to place it on with a protective barrier wipe. (I use an alcohol wipe earlier on in my pod change process.) These seem to help with adhesion without adding a ton of stickiness like regular SkinTac wipes tend to do. They literally do what they say they’ll do, which is make a protective barrier for a piece of medical equipment to stick to easily.

Dry my skin: This seems incredibly obvious, but I make sure that new pod and sensor sites are as dry as possible before I apply a device. This is much more of a problem for me in the summertime when weather causes me to sweat more, but I’ve been able to navigate that by wiping my skin with a clean towel and making sure air is circulating well in the room in which I’m applying the pod or sensor so any excess moisture evaporates off my skin.

I may or may not have tried using Scotch tape in the past to get my devices to stick better…(Spoiler alert: It did not work and I do not recommend.)

Specially designed stickers: Both Dexcom and OmniPod produce stickers that customers can request for free. I get them mailed straight to me and I find that they are most useful when a pod or a sensor is hanging precariously off my body. The stickers are shaped exactly to fit around both, so I never have to worry about missing a spot, and they’ve definitely helped me save more than one pod and sensor in the past. I don’t like wearing them unless I have to, though, because sometimes the extra adhesive seems to make the underlying adhesive weaker (not sure how that’s possible, but I’ve always had more luck waiting to add a sticker on top of a loose pod/sensor that’s in its last couple days of wear than adding the sticker on top in the beginning).

The “circle and press” technique: Most people probably already do this, but I actively have to remind myself that when I apply a new pod or sensor, I need to take my finger and circle it around the adhesive firmly three times in order to make sure it’s pressing up against my skin as securely as possible. This method also sort of irons out any wrinkles that might have appeared when the pod or sensor was initially stuck on, so it’s a simple yet effective thing to do…which is absolutely something we could all use more of when it comes to handling diabetes.

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.