The Top Three Things my Diabetes Devices Get Mistaken For

When I started using an insulin pump and a Dexcom CGM – and even when I switched to a more modern glucometer – I never really anticipated what other people might have to say about these devices. Yes, I figured that people would notice them, and they’d probably occasionally stare out of curiosity (and sometimes, rudeness).

But I never thought that people would think that they were anything but medical devices. I shouldn’t have so much faith in people.

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Can I see the confusion between my old iPod and my glucometer? Um, sure!

Over the years, I’ve noticed a pattern when it comes to what people think my devices are…here are the top three things that my various gadgets are mistaken for:

  1. My OmniPod PDM is typically confused for a beeper. A freakin’ beeper? Helloooo, we’re not in the 90s anymore! Honestly, I can’t even remember the last time that I saw a legitimate beeper/pager device…so it really cracks me up when people ask if I’m carrying around such an old-school piece of technology.
  2. My pods and Dexcom sensors look like cigarette patches, apparently. The first time someone asked me if my pod was a cigarette patch, I asked them, “Do I look like a smoker?” (Not that smokers are supposed to “look” a certain way.) I was more amused than offended, but also kind of awestruck that somebody would confuse a patch that from my understanding is fairly discreet/sleek in design with a lumpy pod or sensor.
  3. My glucometer seemingly resembles an iPod nano. Once, a person asked me why I was wiping blood on my iPod. I wish I was kidding. I’ll allow that my Verio IQ meter and iPod nano are similar in shape and size, but the similarities end there.

Truth be told, it’s actually pretty funny when people think my devices are something other than medical gadgets. And whenever a comment is made and I have to gently tell whoever it is that they’re incorrect in their assumptions about the device(s), I can almost always guarantee that they will end up feeling foolish for what they said. I almost feel bad, but…not really. For the most part, at least I can say that all’s well that ends well, because these interactions usually lead to a valuable teaching moment that the other person won’t forget.

And clearly, I won’t ever forget these moments, either!

 

Precarious Pods and Pure Paranoia

Here’s another previously published blog post from October 5, 2018. What nugget of useful information can you find here? Well, it all has to do with trusting your gut when it comes to an insulin pod that’s dangling precariously off your body and the subsequent paranoia that happens when you’re not sure whether it’ll still work properly…

I’d only been wearing my new pod for about an hour when my arm brushed up in exactly the wrong way against a chair. Riiiiiiiip!

My pod tore right off – not from my arm, but it lifted up from the adhesive that it was glued to and dangled precariously from the still-intact adhesive stuck to my arm.

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Would you have kept the pod on, or changed it?

After cursing loudly, I asked my mother for her opinion. I wanted to know if she could see the cannula, because that was the component that made me most concerned. As long as the cannula was still stuck under my skin and delivering insulin, it shouldn’t matter that my pod was a little loose – right?

She tried to peek under and around my site, but it was virtually impossible to tell whether the cannula was where it should be. I thought about it for a few moments, and decided that it would be wise to just change out the pod. The notion of tossing one that had only been in use for an hour was unappealing to me, but I know myself pretty well, and I know for damn sure that I would’ve been super paranoid about the pod functioning properly for the following 72 hours. I also figured that it couldn’t hurt to try calling Insulet to see if they would replace the kaput pod. The odds were slim, but why not try?

So after I changed my pod, I dialed up Insulet and described the situation to the customer support representative. And…I got a replacement! I was pleasantly surprised by the rep’s empathy towards the situation and how easy it was to get my replacement. She reaffirmed that I did the right thing, noting that if she’d been in my shoes, she would have called it in, too. It goes to show that when in doubt, change the pod – and don’t hesitate to call for a replacement.

The Expired Test Strip Experiment

Nearly every diabetes supply I own comes with an expiration date. Insulin vials, pods, ketones testing strips, and Dexcom sensor/transmitters are among the items that I’m always closely monitoring to ensure they’re still fresh and usable, but test strips? They’re basically the last thing that I worry about.

So I was curious when I recently noticed that my current test strip vial has an expiration date of 12/31/19. Would these strips still measure my blood sugar accurately, or was the New Year’s Eve expiration hard and fast?

I wanted to find out.

The Expired Test Strip Experiment
An introductory blog post to a potentially ongoing experiment.

My experiment design was rudimentary: I’d simply continue to use the 12/31/19 test strips until the vial was empty. I’d check any blood sugar results that I was unsure about against my Dexcom readings, and in cases that I deemed necessary, I’d use test strips with a far-off expiration (July 2020) to see how they matched up with the expired strips.

To my slight surprise, though it’s only been about a week since the old strips expired, it doesn’t seem to affect things much at all. They’re just as accurate as newer strips and my Dexcom.

In fact, in many cases, the old strips were only off (according to my measurements) by no more than 9 points. Not bad. I’ve had a wider spread in results between strips from the exact same vial, so the fact that the old strips were so close to new ones was interesting to me. And four days after the strips expired, I checked my blood sugar (I was 263) and used a new strip to double check that (it read 262). A single point difference is pretty impressive.

So now I know that I’m safe if I use test strips a week after they’ve expired…which is great! But now I’m sort of curious to see just how far out from the expiration date I can use them. I might hang onto this vial of test strips for a few more weeks and continue to test them against newer test strips. I might not (because really, when it comes to diabetes, there are just more important things to be worried about…and I might not want to push my luck and end up wasting strips). We’ll see what I end up doing.

I think that the more compelling questions to stem from this experiment are 1) how many other diabetes supplies are safe (up to a certain limit) to use after expiring and 2) why are supplies labeled with expiration dates if, in the grand scheme of things, they seem to function just fine after expiring? Could it just be a nasty trick played on people with diabetes by prescription drug companies…?

Those are the kinds of questions that really make me wonder.

Do We Take Medical Technology for Granted?

Before I dive into this post, I want to make it abundantly clear that I don’t know the answer to this question. I’m not judging how anyone reacted during the recent Dexcom G6 outage, nor am I stating that there was a “right” or a “wrong” way to handle the situation. I merely think it’s important to ask ourselves questions like this when things don’t go according to plan with diabetes care/management.

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

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Many variations of this graphic have floated around the Internet in the days since the outage. I am not mocking anyone by posting it here; rather, I am using it as an example of ways in which we cope with diabetes difficulties. This example, to me, is an attempt at using humor to deal.

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.

 

Losing Patience with Customer Support

The other day, I nearly LOST IT on the phone with an Insulet representative.

I’m not proud of it, but I also was not sure why this particular phone call was taking so long.

I was calling in regards to a pod failure – something I’ve had to call and report many times before, so I’ve become very familiar with how the usual phone call goes:

Me: Hi, I’m calling to report a pod failure.

Insulet Representative: Okay, could I have your first and last name, date of birth, and shipping address?

*I provide the information.*

Insulet Rep.: Thank you for verifying your information. Could you please tell me about the pod failure incident?

*I explain what happened with the pod failure. The rep will ask me a series of follow-up questions, such as where was I wearing the pod? How long was I wearing it before the failure? Did I notice anything unusual about the pod activation? Did I need to seek medical assistance for the pod failure? Typically, this is the list of questions I’m asked, and then I finish my call with the rep.*

Insulet Rep.: We’ll be sending you a replacement pod. We will send it via standard shipping, meaning it will arrive in 7-10 business days. Is that okay with you?

Me: Yes, thank you.

*And then after exchanging pleasantries, the call is over. Standard running time on the phone is about 6-7 minutes. No big deal at all.*

So imagine my surprise, and growing ire, when a phone call that should’ve only lasted a few minutes stretched just beyond 20 minutes.

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I’m sure that all T1Ds can commiserate with me on this one…how many hours, and how much patience, have you lost due to customer support?

I still don’t really know why it lasted so long. The agent I spoke with was asking me WAYYYY to many follow-up questions regarding the pod failure, and what made it especially irritating was that I’d already explained every single detail surrounding the whole incident. It was like she was questioning my reporting abilities. Either that or she was really slow with taking notes, and maybe I was talking too fast for her? Who knows. All I knew was that I was calling in the middle of my workday, and I had to get this wrapped up ASAP so I could turn my full attention back to my work.

That said, it was difficult to stay patient, and I probably slipped up toward the end of the call. Actually, I totally slipped up, because my answers to her questions became very curt in my attempt to expedite the call…which didn’t work, by the way.

I felt a tinge of guilt for my brusqueness. After all, I used to be a customer service representative who spoke with her fair share of irate customers. I knew it would be appreciated if I at least said a sincere thank you before hanging up. So I did, and even though I wasn’t exactly proud of myself for losing my cool, I was glad that I could turn my attitude around in the end.

It’s kind of a metaphor for how I’m trying to handle my diabetes these days…allow myself to feel how I want to feel, but then go about handling whatever situation is in my way using a level head. Because that’s how to make things happen, IMHO.

WTF is CGM Sensor Soaking?

I saw an Instagram story a few weeks back that intrigued me.

In it, a friend of mine was talking about how she “soaks” her CGM sensors. Instantly, I was confused: What the heck did she mean by that? Soaks them in what, hot water or some other liquid?

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Contrary to the connotation of the word “soaking”, this does not mean you’ll be submerging your CGM in any sort of liquid.

Within seconds, her definition of “soaking” became much clearer. “Soaking” a CGM sensor means inserting a fresh sensor hours before you intend to activate it. Rather than giving your sensor just two hours to warm-up, you’re giving it 4-6 hours so it can supposedly provide much more accurate readings immediately after the warm-up period has ended.

I was interested in this practice because I’ve definitely experienced sensors that were off for several hours post-insertion/warm-up. Sometimes, it even takes a full day for a sensor to start reporting accurate numbers, and I wouldn’t exactly call that efficient.

While I haven’t had the guts to actually try sensor soaking yet – I’d like to sometime in the near future – I’ve been doing some research on it so I’m fully prepared to try it whenever I’d like. Here are some questions I had about the process, and the answers I’ve found to them:

Q: Doesn’t this mean that you’re wearing two sensors at once?
A: Yes. But it’s only for a short window of time, until the old sensor expires and it’s time to activate the new one; in other words, for the full soaking period.

Q: How long should I let a new sensor soak?
A: According to what I’ve found online, it seems that 4 to 6 hours is the sweet spot for soaking. It’s basically doubling or tripling the built-in warm-up period that all sensors must go through, so I can see how this might contribute to improving immediate accuracy.

Q: How do I protect the new sensor if it doesn’t have a transmitter snapped in it for several hours?
A: The reason why I haven’t tried soaking yet is because I was worried about wearing a sensor that didn’t have a transmitter snapped in it. But I found some photos online of people who wore transmitter-less sensors with stretchy, self-adhesive wrap tape to protect the nook in which transmitters rest for the soaking period. It’s smart to protect that space, because in theory, it could be vulnerable to catching on clothing or other surfaces. Plus, tape like that is really easy to remove without damaging the sensor in the process.

Q: What changes about the sensor activation process when it’s finally time to start the new soaked sensor?
A: My research leads me to believe that nothing really changes at the end of the soaking period/when it’s time to activate the soaked sensor. All that will be needed is the sensor code so it can be properly activated within the receiver/Dexcom app. So the most important thing you can do at the very start of the soaking period is hold onto your sensor code/store it somewhere safe so you’ll be able to enter it at the end.

Q: So…why would anyone bother trying this again?
A: My understanding is that it all relates back to making sure a fresh sensor is as accurate as possible once it’s activated. I can’t tell you how many times I’ve put on a new sensor, only to discover a few hours after it has warmed up that it’s off by 40 or 50 points – and that just doesn’t cut it. So I don’t think there’s any harm in me giving sensor soaking a shot one of these days. I just have to remember to do it, and have the patience to wear three devices at once (my pod, the soon-to-expire sensor, and the new soaking sensor).

Have you tried soaking? If so, please drop a comment and let me know your thoughts on it – and be sure to tell me if I missed any key steps in my research!

Ye Olde…Insulin Pump?

Sometimes, you just gotta have fun with diabetes.

Which is why I didn’t think twice before writing “ye olde insulin pump” on my pod before attending a renaissance faire last week.

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Me, wearing a flower crown and showing off my ye olde insulin pump…just living my best life.

Yep, there I am, with my pod in full view, my Myabetic backpack slung on my shoulders, and turkey leg in hand. This is pretty much me in my full glory.

I could’ve let my diabetes get in the way of me enjoying the faire, especially because it’s been somewhat unpredictable lately, but I didn’t.

I ate what I wanted, drank some raspberry wine (much tastier than mead, IMHO), and socialized with friends.

I anticipated some people to notice or comment on my pod, which I actually wouldn’t have minded because maybe it would’ve been from another T1D or someone who is familiar with insulin pumps. But all day long, the only remark came from someone within my group, and we all had a chuckle over it…and that was it.

Which is perfectly fine by me, because even though my ye olde insulin pump and I weren’t trying to hide diabetes at the renaissance faire, it did give me a mental vacation from it for part of the day.

Huzzah to that, indeed.