High…Why?!

Ugh, high again? Why does this keep happening?!

I mused to myself as my Dexcom vibrated incessantly, alerting me to the state of my blood sugar.

I’ve actually been wondering that very thought (and cursing out loud about it) more often than I’d like in recent weeks.

High blood sugar = the diabetes version of kryptonite, at least for me.

It’s been about 3 weeks since I started the Omnipod 5, and I guess my high hopes for the system to revolutionize my blood sugars came to be a little too literally. The 5 has been a godsend in terms of 1) helping me sleep through the night as I’ve only woken up once this month to correct a low OR high blood sugar and 2) catching lows before they happen or before I have to eat something in order to bring my BG back up.

But what the 5 and I are struggling with is the exact opposite of the latter, and that is catching highs before they happen – and then reacting accordingly. I’ve found that I’m dealing with more rapid and prolonged spikes than I thought I’d be. I’m doing what I can to proactively treat them myself by bolusing when they occur, but for some reason, it seems to take a solid 2-3 hours for my blood sugar to come back down nearly every time.

After consulting with some of my diabetes pals about this, and giving it some further contemplation, I’ve got a 3-step action plan to combat these highs:

  1. Give my Omnipod 5 more time to learn my body’s patterns – I’ve heard across the community that it can take several weeks for this to happen most effectively, so I need to try to be patient and wait for the results to occur.
  2. Continue to correct for highs when they occur, and do so swiftly. One of my colleagues said this helped a lot in the beginning, so I will continue to monitor for highs diligently and not be shy about bolusing for them (as long as I’m not stacking insulin too much).
  3. Pre-bolus, pre-bolus, and pre-bolus some more. I’ve always been a believer in the power of the pre-bolus, especially since I know that Humalog typically takes 60-75 minutes to start working in my body. I’m going to build pre-bolusing into my schedule and try to do it at least 30 minutes before I actually eat each of my meals, and we’ll see where that takes me.

Hopefully, this plan of mine coupled with my automated insulin delivery system will nip these high episodes in the bud before long. I can’t wait for “why, high” to become “smooth sailing” and translate into beautiful, level Dexcom graphs!

Omnipod 5: My Initial Impressions

As of this writing, I’ve been wearing my new Omnipod 5 pump for about 2 ½ days. I will be changing my first Omnipod 5 pod later this evening, but before then, I wanted to jot down my initial impressions of the system as a whole so far.

The PDM: A bit larger and more brick-like compared to my Dash PDM. Actually, the size is pretty on par with my iPhone. I like that the screen is larger and it seems more sensitive to touch than my Dash – all good things. Except I can’t figure out why it makes chiming sounds only sometimes after I enter my PIN! I’m sure I’ll learn the cause of that eventually…

The pod: Basically indistinguishable from my Dash pods – the only difference I’ve spotted (or rather heard) has to do with the mechanical ticking sound my pod makes when it’s delivering my basal insulin. The old pods had a set frequency, whereas the 5 pods seem to go “tick, tick, tick” in bursts of three or so. Not sure why, but I know I’m still getting my basal rate delivered, which is what counts.

The set-up: Inputting all of my settings into the 5 only took me about 15-20 minutes. It was so easy that it likely would’ve taken me less time if I wasn’t so thorough and careful about triple-checking my settings. I also think it was relatively seamless for me because I was already familiar with 90% of the PDM’s functionality – the only thing I had (and still have to) explore further is automated mode…see below.

Baby’s first automated insulin delivery system!

Automated vs. manual modes: I can go back and forth between automated (insulin delivery is automatic and the system responds to highs and lows based on data it receives from my Dexcom) and manual (I have to make my own adjustments, just like I did with the older versions of Omnipod). This was a helpful feature for me because I inexplicably got scared of automated mode the first night I wore the pod. I didn’t know what to expect from it – should I trust it right away? Would I notice it working? What if it didn’t? Ultimately, I decided I wasn’t comfortable going to sleep in automated mode, so I kept manual mode on because I wanted to have more control. I waited until the following morning before I turned it on, and since then, I’ve been on automated mode and I’ve spent a solid chunk of my time in range. A few highs here and there, but all my lows seem to be detected before I drop too much, which is just awesome.

Dexcom integration: Similar to the overall set-up of the system, it was extremely easy to get my Dexcom synced up with my Omnipod. All I had to do was enter the 6-character transmitter ID into my PDM and give it a few moments to pick up my Dexcom’s signal. And that was it! I’m sure things will get a little more dicey on days that I have to do both a pod and CGM change (coincidentally, I’m going to do just that in a few hours for the first time…eek), but I do have confidence in my ability to time the changes well so I don’t go without automated mode or Dexcom data for too long.

Let’s talk about sleep: The indisputable best part of this system so far is that I’ve slept soundly the past 3 nights. No CGM alarms going off and waking me up, no frantic shoving of food in my mouth from my bed or late night bolus delivery. And best of all, no waking up in the morning out of range. Now it’s not like that before the 5, I was waking up every night to do something diabetes-related, nor was I starting off each day with a high or low. But I was getting to a point where these things did happen at least on a weekly basis, and naturally, I was getting tired of it. So while I’m acutely aware that I need more time to get to know the system (and it also needs to figure me out), I have hope that it will help me make a major improvement in my diabetes care and management.

All in all, it’s been a relatively smooth start for me and my Omnipod 5. I totally expect some bumps down the road, because that’s normal when starting up any new piece of diabetes technology. But for now, I remain grateful for a comfortable transition to the system.

Diabetes in the Wild: Doggie University Edition

I’ve enrolled my dog, Violet, into Doggie University.

You see, Violet is a perfect pup…except for the fact that she is highly reactive. If she sees another dog on a walk? She barks. A person? She barks. A car? She sometimes barks. A leaf blowing in the wind? Yes, she’ll bark even at that.

Her extreme observation skills are impressive, but not exactly what I’d call acceptable behavior in terms of how a well-mannered dog should react to any external stimuli. So I decided to start formally training her with the help of a local trainer.

Violet loved her first day of school (in which she spent the full day playing with other dogs and getting introduced to some basic commands), but I wanted to be more hands-on with her training. That’s why I got a 1:1 lesson with a trainer so we could work together with Violet.

And it turned into a completely random and unexpected diabetes in the wild encounter – just as they usually tend to be!

Here’s my sweetpea, demonstrating her mastery of the “place” command!

I walked into our lesson and the trainer asked me, point-blank: “Do you have diabetes?”

I was surprised. How did she know? The blank expression on my face must’ve been obvious to her, because she then pointed out that she could see my pod and Dexcom on the backs of my arms. I was literally wearing my diabetes and completely forgot about it.

I said, “Yup, I am! Do you know someone who uses either of these devices?”

She nodded eagerly. “My sister has type 1 diabetes, too, so I’m pretty familiar with all the technology.”

I smiled warmly at her; after all, it’s always nice when a diabetes-in-the-wild interaction is as pleasant and straightforward as this one. We chatted for a couple of minutes, in which I told her about my job working for a diabetes nonprofit, and she shared with me that she’s aware of some of the bigger diabetes organizations out there and “all the great things they’re doing for people with diabetes”. I loved how she acknowledged that, and how seamlessly we were able to transition from a casual diabetes convo to putting my pup to work.

All in all, it was a great lesson for both me and Violet – in terms of how quickly Violet caught onto things and how well that quick diabetes talk went. I enjoy it when people feel free to ask me about my diabetes upfront rather than bemusedly ogle at my devices. It’s a reminder that even when it feels like the diabetes community has a long way to go when it comes to combatting stigma, there’s still plenty of allies out there who really do get it.

Swimming Into a Pod Failure

The latter half of July in New England has been hot, hot, hot this year. It’s almost pleasant compared to last year’s rainy summer months, but let’s emphasize “almost” in that sentiment.

Fortunately, something that makes the heat a bit more bearable is the fact that the condo complex that I live at has a pool! And what’s even better is that it’s pretty easy to find slots of time on the weekends to hang out by it and enjoy it undisturbed by other community members. Case in point? My boyfriend and I found an hour on a scorching Sunday evening to take a dip before grilling some chicken and veggies for dinner.

We had only just entered the pool up to our waists when a familiar screeching sound blared in our ears. Yup…my pod had just failed.

My community pool! Not pictured? My wailing pod!

Rather than get cranky about it, though, I just shrugged and figured it was no big deal, I had to change it in the next few hours, anyways. I was about to rip it off my abdomen when my boyfriend pointed out that the moment I submerged myself more fully in the water, then I wouldn’t hear the screaming pod anymore. Sure enough, he was right – I could only hear the shrill sound when I was underwater, making for an interesting soundtrack whenever I swam under the water’s surface.

We swam and chatted for about an hour before deciding that I probably shouldn’t procrastinate any longer when it came to putting on a new pod. So we dried off and headed inside, and discovered that my blood sugar had lingered in the low 100s the entire time. That was a welcome sight to see – my assumption is that I’d had enough insulin on board from earlier in the day that coupled with the exercise I got from swimming to prevent any sort of blood sugar bump.

So even though I literally swam right into a pod failure, it worked out in a funny way. It’s nice to know that pod failures don’t always have to be a total nuisance.

It’s No Big Deal

“Does it hurt?”

“Wait, no, I’m not ready!”

“I’m LITERALLY afraid that I’m going to hurt you!!!”

These are all phrases uttered by my dear friend who was ultra-curious about the site change I had to do in the middle of our hangout. She wanted to watch me do it, but I stepped it up a notch by asking her to play a key role in it: I invited her to remove my old pod from my leg.

A routine pod change is no big deal to me.

“Just do it, it’s just like ripping off a band-aid. I can guarantee you won’t hurt me.” I said, in an attempt to reassure her. I also swore I wasn’t lying just to make her feel better, because I’ve rarely ever experienced a pod-rip-off that truly hurt.

“But there’s something in you, right? Like a needle?” Her face creased with worry. I smiled and told her that yes, there was a cannula that was in my skin, but I couldn’t feel it.

“Let me start it for you,” I said, when I realized she still wasn’t quite ready to rip it away. I peeled up an edge of the adhesive and she started squirming.

“You don’t have to do it if you don’t want to -” I said, but just as the words left my mouth, she finally tore off the pod. Much to my chagrin, a drop of blood appeared and she squealed as I began to apologize profusely and explain emphatically that it didn’t hurt, it’s just that sometimes blood will appear and nothing can be done about it.

“I can’t believe you have to do this every 3 days…” she said, her eyes widening in wonder. I told her I’ve done it so many times now – literally just over a thousand, according to my calculations – that it’s no big deal. I’m used to it. It’s just life with diabetes…lots of repetition and more math than I’d like.

I accepted my reality a long time ago, and I’m truly at a place where it’s no big deal.

A Bit Bumpy

I spent way too long trying to come up with a good title for this blog post.

Let’s be real, here. It’s hard to think of compelling, descriptive titles that will make people want to read a piece of content. This post was particularly challenging for me because of the subject matter: bumps.

Before you jump to any conclusions, I’m not talking about baby bumps or any sort of metaphorical or literal bumps in the road. The bumps that I’m referring to are physical manifestations on my skin of my diabetes that I find unsightly, which is why I had a difficult time figuring out how to talk about them in a blog post.

I don’t understand why the bumps only appear on my thighs, but…c’est la vie.

Let me elaborate on the exact nature of these bumps. They only show up when I remove a pod that had been on my thigh. No other site experiences this blemish, and no other diabetes device (e.g., my CGM) causes a raised bump to appear on my skin’s surface. The bumps themselves are relatively small – they look a little bit like mosquito bites. You can always tell the exact location that the pod’s cannula was in because the skin looks slightly more irritated and raised there, whereas the skin around that site has a pink tinge to it. These bumps don’t hurt me, aren’t typically itchy, and usually fade in a week or so.

In the grand scheme of things, the bumps probably don’t sound like that big of a deal. But I can’t help but feel self-conscious about them because to me, they’re stark reminders of the physical marks that diabetes leaves on my body. I made peace with having to wear two different gadgets (my pod and my CGM) years ago and having those stuck on my being, but these ugly little bumps? I didn’t exactly consent to having those on my body, too.

I suppose I could solve the problem by avoiding using my thighs as sites for my pods, but to me, that’s just giving in to my diabetes and giving up an extra bit of real estate on my body that I need so I can properly rotate my pod and CGM sites. I’m a little too stubborn to just accept that I shouldn’t wear pods on my legs if I want the bumps to stop appearing. That doesn’t mean that I have to be okay with them, though.

Sharing about the bumps in a blog post is me being vulnerable about a component of my diabetes that embarrasses me. I’m hoping that it results in that shame evolving into a sense of acceptance, or maybe even pride, over my bumps. Because even though they’re far from cute, they do add visibility to my diabetes and represent the strength that my body and mind have developed in order to coexist with it on a daily basis.

Maybe writing this post is the launching point for me to think of these bumps not as blemishes, but as diabadass beauty marks, instead.

A Tough Call: Replace or Keep a Half-Ripped Off Pod?

It was the perfect storm.

My Omnipod’s adhesive was damp from the shower. I was putting a pair of pants and not paying any mind to the pod I’d only been wearing for about 12 hours.

It’s no wonder that I brushed the fabric of my pants up against my pod in precisely the wrong way.

I heard the telltale sound of adhesive tearing off my skin and cursed before looking down to inspect the damage.

I expected to see a pod dangling on my leg by a thread, but instead I noticed that the adhesive around the cannula-end of the pod (the important end) still seemed totally stuck to my skin. It was the opposite end that was in trouble and definitely needed taping up if I hoped to save the pod.

So while I waited for my pod’s adhesive to completely dry from the shower so I could check it out further, I pondered: Do I run the risk of keeping this pod on, even though its security was significantly decreased? Or do I err on the side of caution and replace it, and enjoy the peace of mind that comes with a freshly applied pod?

Both options had pros and cons.

Spoiler alert: I decided to keep the pod on, but made sure it was as secure as it possibly could be by adding an overlay patch around it.

If I kept the pod on, my blood sugars might start to run high because I couldn’t say with 100% certainty that the cannula was still inserted in my skin. It looked like it could be, but the sound of half the adhesive ripping off made me suspicious. But if I replaced the pod, I would be wasting all the insulin I had just put into it the night before, which was a thought that was difficult for me to stomach.

I decided that the more favorable option to me was keeping the pod on, so once I knew it was dry, I added a little extra security by applying a PodPal (an Omnipod-shaped adhesive overlay meant to reinforce a pod’s stickiness) around it. As of this writing, only time will tell whether this was the right call to make, but my point in sharing this story is that this is an example of just one of the many judgment calls that people with diabetes have to make on pretty much a daily basis. This single decision took up mental energy and time that I would’ve rather used at work, or for chores around my house, or for just about anything else – but instead, diabetes had to be at the forefront of my thoughts and actions because it often demands just that much attention.

That’s why it’s kind of staggering to know that people with diabetes make around 180 decisions per day...with that in mind, there’s no doubting that diabetes is a condition defined by choices made. No matter how big or small – even as tiny as choosing whether or not to replace a pod – they all add up together to determine long-term health outcomes, and that in itself is a very big deal.

T1D Tests More Than Just Blood Sugar…

Turns out, living with type 1 diabetes means that I’m testing a whole lot more than just my blood sugar levels…

…I’m testing my memory, too – and rather frequently.

As a person with T1D, it’s on me to remember to do basic things like bolus for meals, be prepared with back-up supplies at all times, get prescriptions filled before I run out of anything, and so much more. More often than not, I pass these memory tests.

But naturally, I’m bound to fail one every now and then.

Case in point: I forgot where I left my PDM the other day. I had prepared my dinner and went to take a bolus for it when I realized that I couldn’t remember when or where I last saw it.

When the “Find my PDM” feature fails, there’s nothing to fall back on other than memory…and maybe a bit of luck, as well.

It was an infuriating scenario. I knew it was somewhere in my home. I hadn’t left the house all day, other than to take my dog outside to do her business. I spent the better part of a half hour wandering up and down the stairs, searching with an increased sense of franticness, for my PDM. The urgency to locate it only heightened when I tried to use the “Find my PDM” feature on the Omnipod Display app and it wouldn’t work. That was a first – up until this day, I’d always been able to use it to track down my PDM when I’d misplaced it. It showed no indication that it was going to suddenly start working again any time soon, so I gave up and was forced to retrace my steps in order to find my PDM…which was going to be difficult considering in the middle of my search, my Dexcom went off, alerting me to an impending low blood sugar.

Think, think, think…I could practically feel the wheels turning in my head as I tried to recall where I last saw my PDM. I’d bolused for lunch earlier in the day, most definitely. That much I knew. I had eaten lunch downstairs, so I surmised that I brought my PDM upstairs with me when I was done so I could have it nearby as I continued on with my workday.

I looked high and low, all around my bedroom, without success. That’s when it dawned on me that there was a slim chance that my PDM fell outside of my pocket when I took my dog out just before I’d made my dinner. So I ventured outside, sweat starting to bead on my forehead as I grew shakier from my low blood sugar. I scoured the parking lot and the lawn for my PDM and no dice. That was when I decided to head back inside, drink a juice box, and take a moment to really contemplate the time and place I last saw my PDM.

That’s when it hit me – it had to be on my bedroom floor, next to my bed, because I suddenly remembered how it had accidentally slipped off my bed when I’d placed it there after lunch! I raced back upstairs, feeling triumphant and relieved when I saw the PDM in that precise spot and could confirm that my memory had finally served me correctly.

Now, this might sound like some silly, random anecdote about how I had a forgetful moment. But to me, it actually demonstrates just how much a person with diabetes needs to remember to do on a daily basis. It’s so much more than the finger stick pokes or insulin injections – it’s a lot of accountability. It shows that diabetes tests a whole heck of a lot more than blood sugar…it tests patience, responsibility, and yes, in this particular situation, memory. This is why I think people with diabetes deserve recognition for dealing with these daily, innumerable tests as gracefully as we can.

Navigating New Insulin Pump Sites and Nerves

This was originally published on Hugging the Cactus on September 7, 2020. I’m sharing it again today because my mom and I were recently talking about pod placements and the places where we would (and would not), hypothetically, feel comfortable wearing a pod. It got me thinking about how I’ve had to work up the courage to try new sites over the years, which inspired me to write this post to hopefully help others who feel the same way about navigating new pump sites and nerves. Read on for more…

Am I the only T1D out there who feels incredibly nervous about trying new insulin infusion sites?

I’ve been this way as long as I can remember, now that I’m thinking about it. Throughout my childhood, I stubbornly stuck to injecting in my arms, legs, and upper buttocks (tee-hee) because those were the areas I felt comfortable with. I don’t think I even considered jabbing myself in my stomach until I was in my teens, and it was only after I realized the importance of site rotation and reducing scar tissue.

So it’s kind of funny that when I went on the OmniPod just over five years ago, I only used my stomach and my lower back (just above the upper buttocks region, tee-hee) for pod placements. It was partly because my guinea pig – I mean, my mom – used those areas for her pods with success, and also because I was hesitant in the beginning to wear my pods on my arms or legs because of their increased visibility.

It went that way for a couple of year – four basic sites ’round my abdomen – when it occurred to me yet again that site rotation was also important for insulin pumpers, not just MDI-ers (multiple daily injection…ers). So I added my upper arms into the mix, and soon after, my upper thighs followed.

The little diagram (courtesy of Insulet/OmniPod) above only shows a few of the sites that people with diabetes use…over the years, we’ve gotten a lot more creative!

But lately, I’ve shied away from wearing pods on my thighs because the area isn’t overly comfortable. When I roll over in my sleep at night, my pod presses up against my leg and the resulting pressure is just enough to disrupt my sleep and make it difficult for me to find a more restful position to sleep in.

As a result, I’ve started contemplating potential new pod sites, and one of the first places I went to for advice was…Instagram! Because…duh.

The DOC (diabetes online community) on Insta is a natural resource for this sort of thing because many people tend to share photos of their sites. It’s kind of a thing. One simple scroll through my feed taught me that people can get very inventive when it comes to finding new locations to place their CGMs and insulin pump infusion sites.

I saw people wearing Dexcoms on their forearms and calves. I saw pods on backs, calves, and even the upper chest area, the latter of which I found most intriguing. For men, it seems like a very accessible spot that causes little irritation, but for women? How the heck did the T1D ladies I saw with pods on their chest deal with it?

The general consensus, it seemed, was that women wearing pods on the upper chest agreed it was a site with great absorption and minimal discomfort.

I was still skeptical, though. I was worried about how it would look if I was wearing a v-neck tank with my pod poking out of, well, my bra! Then it hit me that my pod garners questions from strangers regardless of where it’s located. Furthermore, people will (probably?) be less likely to ask about it if it’s located on my chest because, um, that’s really awkward. My eyes are up here, people!!!

Then I remembered: I could give the site a try without wasting a pod because I have a demo pack that I got from a diabetes conference awhile back! The demo pack comes with a dummy pod that looks and feels just like a regular pod, but there’s no reservoir built into it, so insulin can’t be injected into it.

So right now, as I’m writing this, I’m wearing two pods: one on my upper arm that’s actually giving me insulin, and a fake one on my chest just to see how I like it. I must admit, so far, so good! I slept comfortably with it on last night and I haven’t had any issues wearing clothing or undergarments with it. I even went for a jog with it on and got pretty sweaty, but it stayed secure/I didn’t feel it bouncing around at all (thought the adhesive got a bit too damp for my liking…it stayed on but if I wasn’t careful I totally could’ve knocked it off).

While I’m still having a hard time wrapping my head around an actual cannula piercing my skin at this location (eeeek), now that I know I can handle the pod itself living there, I’m one step closer to trying (and liking) a site that’s more intimidating to me – a win in my book.

The Dazzingly DASHing Drained Battery

Cell phones, eReaders, tablets, video game consoles, PDM devices…these are all electronic devices that rely on rechargeable batteries in order to keep them up and running. Of all those possibilities, which one do I think has the worst battery life?

Unfortunately, it’s my Omnipod PDM.

The speed at which my Omnipod DASH PDM battery drains is alarming…

It’s particularly unfortunate because the fact that the Omnipod DASH has a rechargeable PDM was one of the more exciting features to me when I first started using it. It always bothered me that I had to remember to keep AAA batteries on me at all times with the traditional Omnipod model (I know, I’m making a mountain out of a molehill with that one, but people with diabetes already have to remember to carry so many “just in case” items on us at all times that something like two measly batteries feels like a big effin’ deal). I also disliked how it was pretty difficult to predict when the traditional Omnipod PDM’s batteries would run out of juice (though I eventually did an experiment that helped me approximate the batteries’ lifespan a little better).

So imagine my delight when I learned that my DASH PDM could be recharged! This would feel like second nature to me seeing as I already own so many electronic devices that run on rechargeable batteries. According to the instructions manual for my DASH system, the battery would be able to last 3-4 days on a single charge, so it was nice to know that I’d have to expect to charge my new PDM only once or twice per week.

But in late September – only 4-6 weeks after I started using my DASH system – I noticed a slight issue. My DASH PDM was only holding a charge for a day, maybe a day and a half. This little problem exploded into a significant headache when I went on a trip to California and my PDM died right in the middle of my day trip to San Francisco, forcing my boyfriend and I to troubleshoot quickly.

I should’ve learned my lesson right then and there and called Insulet when I returned home from my trip, but…life happens. My schedule grew extremely busy, then the holidays were here, then I just…well, I grew complacent with having to recharge my PDM on a mostly daily basis. It’s embarrassing to admit it, but I only defend this behavior in a similar way to how I felt about carrying extra batteries on me at all times because there are simply far more important things to worry about when it comes to living life with diabetes. I was fine to coexist with this short battery lifespan if it meant that everything else in my little diabetes world was working okay – and since it was, I didn’t think to do anything about it…

…until recently, when I decided that maybe I should call Insulet and ask for their advice.

Thanks to their wonderful customer service team, I learned that if I were to use any charging cord or plug besides the one that came with my PDM originally, that might contribute to dazzingly dashing drained batteries. That caught my attention because I definitely wasn’t always using the right cord/plug: Often, I was just grabbing the first thing in sight around my condo seeing as so many other electronic devices can be recharged with the same style of cable.

I was reassured that I was doing all of the right things otherwise – silencing alarms when they came up, putting my screen to sleep when I wasn’t using it, and changing my system settings so the screen was programmed to go dark in the shortest amount of time possible. I was also promised a new PDM if, after a few weeks’ time of using exclusively the Omnipod DASH charger, I noticed that it was still having drained battery issues.

Sure enough, the problem has persisted, so I now owe Insulet another call to get my PDM replaced altogether. Here’s hoping that my replacement will outDASH my bad PDM in terms of battery life…