The Missing PDM (and the Panic That Followed)

12:55 A.M. I wake up from a deep sleep to the sound of my CGM going off: My blood sugar had just gone above my high threshold. I silence the alert and reach for my PDM so I can give myself a small correction bolus. But it’s not in its usual spot on my nightstand.

12:56 A.M. I tumble out of bed and wander into the living room. Surely, I left my PDM somewhere out here. I dig through my backpack, check the coffee table, and look for it on the counter tops in the kitchen. I can’t find it in any of those locations.

12:57 – 1:00 A.M. I’m searching all over the apartment, like a mad woman now. I’m checking in between couch cushions, inside cabinets, and underneath furniture at a lightning-fast pace. My heart is beating rapidly as I wonder where the actual eff my PDM could be. I shake my sleep and bemused partner awake, fill him in on the situation, and enlist his help in the search. He only has a vague idea of what the PDM looks like (I have too many devices for him to be able to distinguish the difference between them) and isn’t much help, but he does offer a tip: Check the car.

1:00 – 1:03 A.M. I run down four flights of stairs and into the parking garage where my boyfriend’s car is parked. Maybe it fell out of my backpack on our way to trivia at a restaurant earlier that evening? I rifled through the passenger seat, checking underneath it and even in the backseat, but no luck.

The Missing PDM (and the Panic That Followed)
A post all about a terrifying 20-minute period in which my PDM was…MIA.

1:04 – 1:07 A.M. I practically break out in a cold, panicked sweat as I contemplate the possibility that I took my PDM out at the restaurant and it’s still there. I knew for a fact that I hadn’t used my PDM for anything since I’d eaten dinner hours before at the apartment, but it was worth calling the restaurant to see if they’d found anything. I called, knowing the odds of anyone answering at this hour were slim…only to be proven wrong! I was relieved when a man picked up, and I hastily explained to him the situation. I provided a description of my PDM and waited with bated breath while he searched the area in which my team had sat to play trivia.

1:08 – 1:11 A.M. Crushing disappointment crashes over me like stormy ocean waves as the man tells me, after a prolonged search, that he couldn’t find my PDM. I felt like I’d been punched in the gut. Numbly, I recited my contact information over the phone, thanked him for his time, and hung up. I was beyond panicked now. My boyfriend was asking me about a contingency plan and all I wanted to do was scream at him, my OmniPod IS my contingency plan!!!!!!!! I start formulating a plan to drive to the restaurant first thing in the morning to search the premises myself, as well as call Insulet and beg them to overnight a new PDM. Maybe I would just have to stick to manual injections the entire next day, though I had no idea what I’d do about long-acting insulin since the Lantus sitting in the fridge expired months ago.

1:12 – 1:14 A.M. My mind was in overdrive and I refused to give up right then and there. I was absolutely certain that I hadn’t taken my PDM out since my dinnertime bolus. But since I did go out that night, there were really only one of three places it could be: the apartment, the car, or the restaurant. It definitely wasn’t in the apartment, which I’d searched so thoroughly that it looked like a tornado had whipped through it, but it was worth searching the car one more time…just to be positive.

1:15 A.M. I make my way back down to the parking garage. I turn my cell phone’s flashlight feature on and scan the seats carefully, peeking under and over and around every possible surface…I didn’t see a damn thing. Defeated, I turned to close the passenger side door when, out of the corner of my eye, I saw a gray object wedged between the door would be when it was slammed shut and the seat. It was practically camouflaged, that’s how well it blended with its surroundings. It was…MY PDM!!!

“Relieved” doesn’t begin to describe how I felt. “Elated”, “victorious”, and “exhausted” are all better descriptors. I ran back up to the apartment, told my boyfriend, and breathed a deep sigh, glad that the entire episode had a happy ending. We settled back into bed, though I lay there staring at the ceiling for a long time afterwards. If I hadn’t double checked the car, my boyfriend would’ve just driven off to work the next day, both of us oblivious to the fact that my PDM was there. I would’ve wasted time trying to track it down at the restaurant and calling Insulet, and there probably would’ve been a lot more frustration felt and tears shed.

But thank goodness it didn’t come down to that.

The end results of the missing PDM episode was 1) losing a decent night of sleep, 2) feeling an urgent need to establish a better contingency plan, and 3) feeling an even more pressing need to install a tracking device in that damn PDM, stat…because that thing is just too easy to lose.

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?

HUGGING THE CACTUS - A T1D BLOG
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!

Do Dexcom G6 Readings Become Less Accurate as Transmitters Age?

In my unofficial opinion: Yes, Dexcom G6 transmitters lose accuracy as they approach their expiration dates. And I’m not quite sure if I’m the only one who has noticed this, or if others have also experienced this frustrating phenomenon.

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In my unprofessional opinion, yes!

I’m writing this after dealing with a dying transmitter that was showing its signs of decay by 1) losing connectivity with my receiver and 2) reporting inaccurate blood sugar readings. I’ve definitely narrowed the problem down to my aging transmitter, which (allegedly) had one session left before it was set to expire – everything else about this particular sensor session was standard procedure. And guess what else, everything about the entire 10-day session was obnoxious, because it was rare for me to have a single day with both accurate and consistent readings. Ugh!!!

I don’t know what’s more irritating – the signal loss or the inaccuracies. Actually, I DO know what irritates me more than anything else, and that’s the fact that the transmitters don’t seem to last for as long as they’re advertised. It’s just ludicrous, especially when you take into account how much these devices cost.

Many people with diabetes rely on this, and other forms of technology, to effectively manage diabetes. And when the technology can’t be relied on to do its job, we can’t perform our jobs as well. Diabetes is draining enough – is it too much to ask for technology to be trustworthy?

Trying to Stay in the Loop with DIY Diabetes

I can’t remember exactly when I heard of “DIY diabetes”, also known as “looping”. It may have been at a conference a few years ago, or maybe I saw something about it on social media. Either way, it seems to have totally blown up as more and more people with T1D are looping.

TRYING TO STAY IN THE LOOP WITH DIY DIABETES
Are you a Looper?

Before I talk about it more…a brief definition of looping. Loop refers to a kind of automated insulin delivery system. According to what I read about it on diaTribe, Loop systems are open-source and DIY, meaning that T1D Loopers download an app for the iPhone that communicates with a device that also communicates with compatible pumps and CGMs.

If you’re confused, don’t worry – so am I. There’s a number of moving pieces involved with Looping that make it daunting and difficult for me to keep up with as the technology changes. But the ultimate goal of Looping is what has me interested in it. Looping is supposed to help improve time-in-range, particularly overnight, because it does a lot of the thinking for you and ultimately makes life with diabetes easier. And I’m all for that.

Looping’s been popping up on my social media a lot lately because at the end of April, the geniuses behind Loop announced that compatibly with the OmniPod for the first time. (Previously, Looping was only available to Medtronic folks.) On what feels like a daily basis, I notice more people on my social media platforms – particularly Instagram – who are Podders that have made the decision to start Looping. The common denominator with many of these individuals, besides being Looping Podders (sounds like a wacky band name) is that they’ve found great success in doing so. It seems like each person spends 90% or more of his/her time in range, encounters fewer low/high blood sugars, and wastes less time worrying about diabetes in general.

All of that sounds too good to be true. Of course my interest is piqued by such incredible results, and of course I’d love to dive right into Looping and see whether it’s a good fit for me. But the reason why I don’t is simple…I just hesitate to trust new technology.

Technology can fail. Plain and simple. All operations for Looping with the OmniPod take place on the iPhone. That means that the PDM is rendered useless. What happens if I lose my cell phone? What if the battery dies when I need to bolus? What do I do when I upgrade to a new phone? There are so many questions I can think of related to the phone issues alone, never mind any other potential problems. Put simply, the unknowns – the “what ifs” – terrify me so much that I can’t help but be skeptical of Looping.

But this doesn’t mean my interest goes away. My curiosity about Looping is stronger than ever. The DIY element is frightening, but the rewards could be greater than the risks.

The only thing I know for sure is that I won’t even attempt to Loop until I have a conversation with my endocrinologist about it. Together, we make decisions about my diabetes care and treatment that we both feel are safe and right for me. I’d love her opinion on Looping to see how much she knows about it and whether she has any patients who use it. Until I talk to her and gain more information from other Loopers, it’ll just be something that I cautiously admire from afar on social media.

The Red Wedding

If you’re reading this post and knew immediately what the title was referring to…rest assured that what you’re about to read is not nearly as dramatically violent as The Rains of Castamere episode of Game of Thrones. I just chose the title because it semi-accurately described what I encountered with my CGM at a weekend wedding I recently attended. And because the final season is here in a mere FOUR DAYS and I’m struggling to hold in my excitement/terror/anticipation.

Anyways, the day of said wedding began normally, if not a bit early. I put on makeup and a nice dress, tried (and somewhat failed) to curl my hair, and ate a light breakfast. Somewhere between slipping on my jewelry and singeing my hair with the curling iron, I heard my CGM’s alarm blaring, notifying me that my blood sugar was going up. That wasn’t surprising, since I’d just eaten food. But I was caught off-guard when it stopped alarming after two alerts went off…I hadn’t dismissed the previous two, so why was it no longer making any noise?

I checked the app on my phone and saw “sensor error” on the screen…and said out loud, “NOT today, diabetes,” as I promptly stopped my sensor and ripped it off my body. I didn’t even hesitate to do it because I knew that the sensor was due to be changed that evening, anyway, so I saw no harm in doing it a bit early.

“What?” My partner yelled from behind the bathroom door.

“Nothing, nothing,” I said dismissively, which reflected my determination to just brush this inconvenience away and stick a fresh sensor on my body.

Oh, if only it were that simple…

It should’ve been an easy, routine sensor change; alas, upon pressing the button on the insertion device, I let out a little pained squeak. Sensors don’t normally hurt, but every now and then, I get myself in a sensitive spot. And I definitely did this time around. Before popping the transmitter into the sensor, I noticed a bit of blood pooling underneath the sensor’s adhesive.

Save the date

Pools of blood as I make my way to a wedding…do you get the red wedding connection now?

Fortunately, this tale has a happier ending than it did for much of the *spoiler alert* Stark family. Sure, my sensor kinda freaked out when it warmed up two hours later and measured blood instead of interstitial fluid, and it took like 12 hours for it to get its act together and display my readings accurately, but…it all worked out in the end. And thankfully, not a single person had any clue that there was a patch of blood on my belly throughout the wedding…it didn’t even stain through my dress.

Is a Bleeder a Reader? My Take on a Bloody Dexcom G6 Insertion

This blog post probably shouldn’t be read by anyone who gets squeamish when discussing blood or when viewing photos that show any amount of it…my apologies in advance for a bloody gross blog post, but I thought this was a good topic for discussion. 

I placed the new Dexcom G6 sensor on my abdomen, hovering my index finger above the large orange insertion button. I pressed it, exhaling as I felt the minute needle pierce my skin’s surface. I looked down, and started to rub the adhesive in circles to make sure it was stuck, when I saw blood. Not just a drop, but a decent-sized pool forming beneath the sensor. Before long, just about the entire surface of the white adhesive was soaked in red.

Yeah, this was going to be a no-go.

It’s pretty rare for me to experience blood at the site of a Dexcom sensor. If I had to put a number on it, I would say less than 10% of my insertions draw blood. An even smaller amount – like, 2% – have caused me to bleed as much I did in the scenario described above. But I know I’m not alone in my bloody sensor experiences – it’s something that many other T1Ds who use a Dexcom have gone through.

There’s a bit of debate, though, that I’ve noticed in the past on Twitter threads and Instagram posts. What to do with a bleeder? Keep it and assume that it’ll read blood sugars normally? Or change it immediately and call Dexcom for a replacement?

Are bleeders readers? Or does it depend?

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Do you think that bleeders are readers?

I’m going to go with…it depends.

Obviously, in that situation I described in the opening of this post, I decided that it wasn’t a good idea to keep the sensor on my body. There was too much blood and I didn’t trust that it would adhere well to my body. I didn’t know how long it would take for the blood to stop (only a few minutes, but still), and I couldn’t be sure that it wouldn’t mess up my readings. On top of that, I wasn’t trying to stain my clothing, if I could help it.

So in that circumstance, I did change my sensor right away, and was glad that the second try resulted in a much cleaner, blood-free insertion. I called Dexcom, explained what happened to the customer support representative, and got a replacement sensor mailed to me.

However, just about any other time I bleed upon a sensor insertion, it tends to be a minuscule amount of blood. I usually don’t even notice until it’s time to replace the sensor, and there’s a bit of dried blood left on the site. Other times, I’ll see small beads of blood forming underneath the spot where the transmitter snaps in. And there’s been a couple of occasions that I’ve bled a fair amount and been totally unaware of it until I caught my reflection in the mirror and noticed the blood staining the white adhesive. And in all of those cases, I’ve kept the sensor on for the full ten days, without noticing any discrepancies in my readings.

All that considered, in my inexpert opinion, I think that bleeders usually are readers and that they’re safe to continue wearing. Of course, there will be exceptions, like when there’s just too much blood to salvage the sensor. But every time I’ve kept using a bloody sensor, I’ve had the same amount of success with its functionality…so yes, I think that for me, bleeders are indeed readers.

 

My CGM Sensor Ripoff

Oh, the Dexcom G6. You have no idea how much I simultaneously love and hate you. I love you for your painless insertion, increased accuracy, acetaminophen-blocking capabilities, and your sleeker profile. But I effing loathe you for having communication issues with the sensor on days 9 and 10 of wear…that is, if you even last that long on my body. You have serious sticking issues, old pal. Your adhesive tends to be a bit of a ripoff – both literal and figurative.

You see, I was just trying to roll over into a more comfortable position in the middle of the night when you decided right then would be the ideal time to just fall off my arm, prompting me to go from blissfully snoozing to wide awake and angry in less than 10 seconds. Way to go! It pissed me off because it happened with very little effort. I would’ve understood if I had scratched or touched it in any way, but all I had done was flip from sleeping on my left side to my right. Not fair and definitely not the ideal way to wake up.

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The ripoff sensor in question.

I wish I could say it was a one-time occurrence, but no, it happened a couple months ago. Again, it was the middle of the night and again, it was ripped off prematurely. I think that in both cases, I still had at least another three or four days of use before it was due to be changed. And even before these two middle-of-the-night ordeals, I had trouble with a freshly inserted sensor that was peeling all around the edges. What the heck is going on with Dexcom G6 adhesiveness?

Maybe this is a sign that I need to start using something in addition to an alcohol swab each time I change a sensor. Perhaps Skin-Tac or more regular usage of Pump Peelz/Grif Grips will prevent future sensor ripoffs. But still can’t help feeling ripped off, because this never really happened when I was using my G5 sensors.

The small mercy in this situation is Dexcom customer service. Kudos to their team for being understanding and willing to replace my not-so-sticky sensors…but I wish I could say that I had more faith in a G6 sensor’s ability to stay on my body for the full 10 days that it was intended to.