Sensor Snapping by the Seashore

Sensor snapping by the seashore…try saying that five times fast.

The past several weeks have been so busy that I completely forgot about an incident that occurred when I was away on vacation in July.

An incident that I’d never experienced in my decade of using Dexcom CGMs…

It was the second-to-last day of my trip. I was blissfully soaking up the sun’s rays – it was by far the best beach day of my entire week in Maine. That meant that the sun was strong that day…so strong that I was basically applying sunscreen every hour, on the hour, because I am as pale as Casper the friendly ghost.

During one of my sunscreen applications, I noticed that the Dexcom sensor on the back of my arm was looking a little off. I mean that literally – the transmitter seemed like it was jutting out at a weird angle. Upon further inspection, I realized that the grayish-purple prong that helps keep the transmitter in place was hanging on by a thread. I was pretty surprised to make that discovery, for a few reasons: 1) I didn’t know that could happen, 2) the sensor was only about 24 hours old and nothing went awry during the application process, and 3) I couldn’t remember bumping into anything that would’ve caused a plastic piece to break off my sensor. But the most surprising part was that it was enough to cause my sensor to stop collecting readings altogether – I was getting an error message on my Dexcom app.

My broken sensor prongs and me, sitting on the beach.

I didn’t know what to do other than carefully break the prongs off all the way – they weren’t going to do me any good now – and gingerly press my transmitter down into my sensor for several minutes to see if that did anything…and no dice. I resorted to plan B, which was to wait until I got back to the house I was staying at to do some more research into the matter.

Unfortunately, the internet had nothing helpful to offer me. I was somewhat relieved to know that this has happened to other people, but definitely bummed to learn that there wasn’t a real solution other than to apply a new sensor – which wasn’t an option for me since I had only packed the one sensor for my trip. Whoops. So much for me being the diligent, prepared T1D that I thought I was.

Ultimately, I decided to rip the sensor off and deal with finger stick checks for the rest of my trip; after all, I was going to be returning home the next day. I look at the whole incident as yet another example of why it’s important to pack extras of my extras, and as a reminder to expect the unexpected in life with diabetes!

The 1 A.M. Cupcake

Zzzzz…huh? What’s that? I was sleeping so deeply…

Oh, I’m low.

Dazed, I roll out of bed and suddenly become aware of how hot I am. Beads of sweat are rolling down my back, making my pajamas stick to my skin. I look at the number on my Dexcom – there isn’t one.

It just says LOW.

I grow more alert and turn to my test kit to do a fingerstick check and verify my Dexcom reading. My meter says that I’m 44.

And suddenly, I’m feeling that low. I need sugar, stat. I could open the bottle of glucose tabs conveniently perched on my nightstand, chew 5 or 6, and then get settled into bed and fall back asleep relatively quickly. But the desire to get downstairs and eat the contents of my kitchen strikes, even though it’s 1 A.M. and eating too much at this time of night wouldn’t be good for either my blood sugar or my sleep hygiene.

Ignoring my more rational side (as well as my glucose tabs), I grab my phone, my meter, my PDM, and my bathrobe and stumble down the stairs in the dark. I turn on the ceiling fan in my living room in a desperate attempt to cool down faster before I walk into the kitchen.

My eyes fall on a cupcake sitting innocently on the counter.

This isn’t a picture from this particular incident – nobody wants to see me when I’m this low – but this is one of the cupcakes that I’d made. Violet always wants me to share.

I don’t think twice – I tear the wrapper off and three bites later, it’s gone.

I collapse on the couch, directly under my ceiling fan. I am a sweaty mess. This low is hitting me hard. I put the TV on in a futile attempt to distract myself while I wait for the cupcake to kick in, but instead of paying attention to what’s on the screen, all I can feel is gross for choosing to eat a damn cupcake at 1 in the morning instead of doing the “right” thing and treating my low from the comfort of my bed with glucose tabs.

20 minutes later, I start to feel chilly. I’m no longer perspiring and I feel all of my low symptoms subside. I’m better, so it’s time to head back upstairs and try to fall back asleep.

I toss and turn for a bit, cursing diabetes and its middle-of-the-night low blood sugar curveballs, and the stupid 1 A.M. cupcake that my diabetes somehow convinced me to eat to treat a low instead of waiting to have it at a time that I could actually enjoy it.

Diabetes strikes again, I think as I drift back to sleep.

80 Days Later…

80 days.

That’s how long it took for me to receive the letter from my health insurance company notifying me (at long last) that the pre-authorization for my Dexcom supplies came through – and more importantly, was approved.

Those 80 days were fraught with anxious thoughts. On a daily basis, I wondered…

When would I get my next Dexcom order? Answer: Almost three full months after I started my new job and switched health insurance.

Would I even still be able to use Dexcom under my new health plan? Answer: Yes, although I wasn’t sure for a long time seeing as I didn’t find out until recently that I needed a prior authorization in order to get Dexcom coverage.

Why was it taking so long? Answer: It took so long partly because this stuff can be time-consuming. I work full-time, maintain a home, care for my dog, and juggle a jam-packed social calendar…and don’t often have the bandwidth to be waiting on hold with my doctor’s office, my health insurance provider, and my Dexcom supplier. I was counting on all three of the aforementioned parties to do a little more of the heavy lifting for me when I should’ve depended on myself alone to make sure I got my supplies as quickly as possible.

What was I doing wrong? Answer: Honestly, even though I sound like I’m shouldering most of the responsibility in the latter paragraph, I don’t think it’s fair to pin this all on me. Sure, I could’ve and should’ve hustled harder to get my Dexcom supplies, but I put trust in a system that I already knew is fundamentally broken. Health insurance can be ridiculous complicated to understand and contend with. I’d never needed a prior authorization for anything before, so that concept was new to me. Throw a new health plan that I had zero familiarity with into the mix and I was bound to encounter some bumps in the road to get my supplies.

I was so excited to get this letter in the mail that I took a damn picture with it.

That’s why I almost cried tears of relief and joy when I finally got the letter from my insurance company that informed me my Dexcom supplies were approved. The waiting period was over. 80 days of fretting over whether or not I’d have access to a tool that has revolutionized my diabetes care and management was absolute agony. That period of time also represented the first time I was truly worried over whether or not I could continue with the diabetes regimen that works for me. I was trying to remember the days before my Dexcom, the days that I had finger pricks and finger pricks alone to base my diabetes decisions on.

I could scarcely remember those days. And the fact that they could’ve become my new reality if I didn’t figure out the Dexcom situation frightened me.

I feel very fortunate that I was eventually able to successfully place an order for my Dexcom supplies under my new health plan, but I also feel rage that the system made it so difficult, as well as utter heartbreak for those who don’t have choice when it comes to diabetes supplies or even access to life-altering (and life-saving) medications.

I’ve said it before and I’ll say it again…our healthcare system is broken. Choice and access matter.

They matter most of all when lives depend on it.

A Diabetes Waiting Game

I am smack-dab-in-the-middle of a very long, very annoying diabetes waiting game.

I’ve waited for my Dexcom sensors and transmitter refill for two months now.

I’ve waited to transition to the OmniPod DASH system for a few weeks now.

I’m very glad, and fortunate, that this waiting game does not apply to the most crucial of my diabetes supplies, which is of course my insulin.

But I’m still tired of waiting.

I don’t mind it as much for the OmniPod DASH; after all, I’d rather use up my remaining pods before diving right into full-time use of the new system.

But the Dexcom sensors and transmitter? That wait has been borderline ridiculous.

I may have to wait to use my new DASH pods, but at least I have ’em here when I’m ready to put them in action.

To sum it up, the wait is due to a series of miscommunications between me, my doctor’s office, my health insurance provider, and my DME (durable medical equipment) provider. And it sucks, because just like anyone else who has diabetes, works full-time, manages a household, and has a social life, I’m doing everything I can to address the matter when I have the time and mental bandwidth to do so, but still blame myself for not getting my prescriptions sooner.

It sucks that I feel failed by the healthcare system.

And again, I find myself feeling grateful that this is my first time experiencing anything like this in 23ish years of life with diabetes. But what’s opened my eyes is that this is a reality for some people with diabetes all the time. That doesn’t just suck – it’s unacceptable.

When will we stop having obstacles block the paths to getting essential, life-saving medications and equipment?

Swimsuit Season is Here and My Diabetes Gadgets and I are Not Ready

A “yay”: Summer is here!!! Hooray for warm weather, beach trips, and backyard BBQs! (Not to mention VACCINES!)

A “nay”: My pods and my CGM sensors are about to bare themselves for the world to see and we are NOT READY for it.

My confidence in my appearance is rarely, if ever, high. But I like to fake it ’til I make it and act like I’m rocking my summer wardrobe instead of stressing about how my legs or arms look in the staples of the season that are designed to show more skin.

Usually, I have a lot more success in feeling good about how my medical devices appear on my body. Whether they’re hidden under my clothes or out for the world to see, I typically don’t care because these gadgets are keeping me alive!!! And that’s a lot more important than any negative body image connotations they may create.

A picture from a time during which I was very okay with PDA (public displays of my arms).

But something about this year feels different to me. I am so not looking forward to the extra stares that my diabetes technology attracts. I’m not sure if it has to do with being sheltered in the last year and a half because of the pandemic, but whatever the cause may be, this is something I’m grappling with as the temps creep up and the temptation to hit the beach grows stronger.

I know I’m not the only one dealing with this. In fact, I was in Maine for a couple of days with my parents and I was wearing my pod on my leg, whereas my mom had hers on her arm. And we had multiple people approach us about our pods! They weren’t necessarily rude in their approaches – curiosity drove them to speak with us and that’s innocent enough – but it’s still weird to know that people are looking closely enough at our bodies to see our devices and feel comfortable enough to ask us about them. Plus, I felt extra self-conscious about it because in typical Molly fashion, I had a sunburn all around my pod thigh site…when applying sunscreen, I almost always miss the area directly around my pods because I’m afraid of the sunscreen making my adhesive weaker or interfering with the pod’s functionality. So not only did I have this big chunk of plastic sitting on my leg, it was also red all around the site, drawing even more attention to it. It was a relief when I was able to put shorts on over my swimsuit and cover up both the burn and the pod.

So while I’m not loving how wary I’ve felt lately about baring my diabetes devices, I’m also coming to terms that it’s just a sort of phase that I’m going through right now. And that’s okay. I’m also trying to remind myself that I don’t have to feel obligated to go into detailed explanations when people ask me about my pod or CGM. It’s a natural tendency that I have to use it as a teaching moment and be a good diabetes advocate, but sometimes I just don’t have the energy for it. I’m keeping my fingers crossed that as the summer season goes on, my comfortability with my diabetes devices increases and I worry less about the looks they tend to draw.

Trying to Outwalk a Low Blood Sugar

I was a mile into my regular morning walk when the beeps started.

Dammit.

The beeps were coming from my Dexcom app on my phone and they were alerting me to a low blood sugar. Rather than correcting the low, though, or even opening up the app to dismiss the alarm, I just kept walking.

Outwalk the low blood sugar, Molly.

Outwalking a low blood sugar is easier said than done.

I really couldn’t understand why my blood sugar was low in the first place considering that I had no food in my system or insulin on board (other than my standard basal rate). Fasting workouts tend to virtually guarantee stable blood sugars for me, which is wonderful because otherwise exercise tends to make me crash. But what was different about this morning? I was utterly befuddled. My Dexcom alarm chimed a second time.

Outwalk the low blood sugar, Molly.

Even more confusing was my complete and utter determination to not treat the low blood sugar until I got home. I had glucose tablets on me, so it’s not like it was a matter of lacking a treatment. Rather, I think I was more focused on maintaining my fasted state for as long as possible, since I almost always do an exercise circuit (weight lifting, cardio training, HIIT intervals, etc.) when I return home from my morning walks. My low alarm rang a third time, just as loudly as it had before.

Outwalk the low blood sugar. You’re only 15 minutes from home.

I was deaf to my Dexcom’s persistent alarms for the next 15 minutes as I somewhat floundered down the road home, letting my impatient puppy tug me along. It’s almost like she knew that I was low and was trying to hurry me home, and I was 100% okay with that because my brain was starting to get fuzzy.

Outwalk the low blood sugar…

At long last, nearly half an hour after my first low alarm sounded, I was crossing the threshold of my front door and fishing my phone from my bag. I tapped through my notifications and cleared the low alert, noting that I was 66 mg/dL and definitely needed to eat something before continuing on with my morning routine. I sighed, set my sight on the kitchen (where a low blood sugar food stash awaited me), and resigned myself to the fact that I couldn’t outwalk the low blood sugar this time.

Ask Yourself These 6 Questions Before Trying New Diabetes Technology

This blog post was originally published on Hugging the Cactus on May 13, 2020. I’m sharing it again today because I think it’s super important to weigh the answers to these questions before deciding to try new diabetes technology. This is coming from someone who waited 17 years before she tried her first insulin pump, and even though it has had an enormously positive influence on my life and sometimes I wish I’d tried it sooner, I’m ultimately glad that I waited that long! Read on for more details…

So you want to try your first continuous glucose monitor. Or maybe you’re ready to leave behind multiple daily injections and switch to insulin pump therapy. Whichever diabetes device you’re looking to start using, there are some questions you’ll probably want to have answers to before decide that now’s the time to introduce new diabetes technology into your daily routine.

The following is a compilation of the questions that I thought long and hard about (literally for years) and that I wish I’d thought long and hard about before I made the transition to the OmniPod insulin pump.

1. Am I ready for it? It took me 17 years before I decided that I was ready to try an insulin pump. 17 freakin’ years!!! I spent most of that time being too afraid of introducing such a drastic change to a routine I’d had down pat for such a long period of my life. There are times when I wish I’d gone onto my insulin pump sooner, but ultimately, I’m glad that I wasn’t swayed by my family or doctors to go on it before I truly felt ready. By the time I started using my OmniPod, I had the maturity, responsibility, and emotional intelligence that I felt that I needed for an insulin pump.

2. Will I be able to afford it? Obviously, this isn’t a question that I wondered about when I was younger, but it’s one of the first things that comes to mind as an adult on her own health care plan. We all know that diabetes supplies are expensive, and it seems that the more technologically advanced something is, the more money that has to be forked over in order to obtain it. This isn’t right or fair, but it’s a simple truth and an important one to think about before choosing one pump or continuous glucose monitor over another.

3. Why do I want to start using it? I wanted to start using my OmniPod because my mom experienced great success when she started using it. And I decided to get a Dexcom CGM because I fell in love with the technology after undergoing a trial period with my endocrinologist. In both situations, I felt very much in control of my decision to start using these devices and I didn’t really listen to anyone else’s opinions. But I am very aware of the fact that social media and real-life friendships with other people with diabetes can often sway people in different directions. After all, if I saw a post on Instagram from a dia-influencer who was singing the praises of a Tandem T:slim pump, then I might seriously start thinking about switching to it (this has actually happened to me). But the bottom line is to think about the why – will this device enhance quality of life for me? Will diabetes be easier to manage with it? Will it help me achieve my A1c and/or blood sugar goals? Do I need to add something new to my routine because I’m feeling burnt out by doing things the same way all the time? Knowing why I wanted to use an OmniPod or a Dexcom CGM made me feel that much better during the whole process of learning how to use them – I felt like I had clear goals that would help me navigate the integration of these new technologies into my daily routine.

Did you know that Insulet/OmniPod has demo pods that you can wear? They don’t hold insulin or deploy a cannula, but they can give you a good sense of what it’s like to wear a pod on a daily basis!

4. Will I be comfortable wearing it 24/7? This is a big one! Pods, pumps, and CGMs are very visible, and it can be jarring to go from being “naked” to having bumps and lumps underneath clothes that can get caught on doorknobs, chairs, and the like. Personally, the benefits of my OmniPod and Dexcom outweigh something like this which is a bit superficial, but that doesn’t mean it’s not something to think about. But it’s also worth thinking about comfort and what is least painful when it comes to insulin delivery, so that’s why this is an important question to ask.

5. Do I know anyone else using it who can provide feedback from a patient’s perspective? I’ve talked about this before, but I’m not sure when, if ever, I would have seriously considered using the OmniPod if my mother hadn’t tried it first. The fact that we both have diabetes has probably made us a little closer and strengthened our bond, so if there’s anyone’s opinion that I’m going to trust when it comes to something like this, then it’s hers. I can actually remember her first few weeks on the OmniPod – in which she learned a lot of valuable lessons – and how pleased she was with it once a few months with it elapsed. She taught me the ins and outs of the OmniPod when started to use it, and I’d argue that her advice was more helpful than that of my diabetes educator. So I’d advocate gathering opinions from family and friends (if either is applicable) or the diabetes online community before going on a new diabetes device, in addition to the research component below…

6. Have I done enough research on it? …Like any smart shopper, it’s crucial to really consider all options and research them thoroughly, especially when it comes to the top contender. I definitely did not complete sufficient research before going onto the OmniPod or Dexcom; rather, I trusted that they were just right for me. If I were to switch to something else tomorrow, though, you can bet that’d I’d spend a lot of time scouring the web for every last bit of information on the device so I could make the most informed decision possible.

New diabetes technology can be both scary and exciting. But more than anything else, it can really make life with diabetes much more carefree, and I’m glad that in this day and age there are so many options available to people with diabetes that continue to be technologically impressive

CGM Sensor Adhesive: Not as Sticky as It Used to Be

I’ve had four CGM sensors fall off in the last six weeks or so.

Four! And they’ve all been in different locations, too – both the left and the right sides of my thighs and my stomach. I’ve worn overlay patches – at times multiple – to help keep them on, and I’ve still dealt with adhesive that just doesn’t want to lay flat against my skin.

What gives? I can’t recall a time in which I’ve had worse luck with my CGM sensors staying stuck.

I’ve gone through quite a few overlay patches in the last few weeks in an attempt to get my CGM sensors to stay stuck on my skin…with mixed success.

Normally, I’d blame it on weather, but it hasn’t exactly been warm here in New England yet. Temps have mainly stayed in the 50s and 60s, so it’s not like I can pinpoint the problem on heat.

The only silver lining in this scenario is that Dexcom does have a nice replacement program. They make it really easy to submit a patient support request online that goes straight to Dexcom support for processing. Filling this form out takes me no more than five minutes and by doing so, I’ve received a replacement sensor for each one that’s fallen off in the last month and a half. And while I was starting to worry that I was submitting too many requests, Dexcom hasn’t further inquired me on the matter yet, so I feel a little better knowing that I can count on them to give me replacements for sensors that won’t stay stuck.

Until the adhesive improves, though, it looks like I’m stuck wearing at least two or more overlay patches on my sensors to ensure their 10-day lifespans.

I guess they just don’t make ’em like they used to…

Do You Know What It Means to “Sensor Soak” Your CGM?

This post was originally published on Hugging the Cactus on September 27, 2019. I’m sharing it again today because I still find the concept of “sensor soaking” to be fascinating, though I haven’t been brave enough to try it yet. Not sure what sensor soaking is? Read on to find out…

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?

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!

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.