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.

The Major Diabetes Mistake I Made

I recently experienced a diabetes first: I bolused myself for 10 units of insulin instead of the one, single unit that I had intended to give myself.

Whoops.

Major whoops.

This careless mistake occurred because I simply wasn’t paying attention when I was inputting numbers into my PDM. I thought I had entered “10” as the amount next to the number of carbs I was about to eat when in reality, I overrode my PDM’s suggestion from 1 to 10 in the total bolus calculator. And I didn’t even realize this until I heard my pod beep randomly several minutes after I’d fiddled around with my PDM. Thank goodness I did notice that beep; otherwise, I would’ve been alerted to my mistake about an hour later when my blood sugar would inevitably start to plummet.

Upon hearing that beep, I decided to check my PDM to see what was up – I assumed that maybe I had a temp basal running that I’d forgotten about, and my pod was just letting me know that it was finished. Obviously, this was not the case. When I saw that I’d bolused 10 units, a wave a panic crashed over me and I immediately started crying. My poor mother, who witnessed me making this discovery, started inquiring what was wrong and I explained to her what I’d done while I brushed angry, frustrated tears off my face. I was in disbelief that I’d done something so stupid. My mom, though, brought me back to reality and redirected my attention to the fact that I should prioritize finding food to eat that would ensure that my blood sugar wouldn’t crash any time soon. I remember taking a breath, then scanning the kitchen for something high-carb that would kick in sooner rather than later.

My eyes landed on cereal, which is notorious for causing blood sugar spikes but also incredibly easy to eat lots of…especially when you aren’t overly hungry but desperately need to eat in order to avoid a scary situation.

See my finger hovering over the digital touchscreen of my PDM? It’s pretty dang easy for said finger to slip and hit a number when I didn’t mean to do so.

So I poured myself a big bowl of Life cereal mixed with Cheerios – not my first choice when it comes to cereal, but that’s what was in my parents’ pantry and this beggar really couldn’t afford to be a chooser, given the circumstances. I sat there and stewed as I ate what was probably the least enjoyable bowl of cereal of my life because I was too busy cursing myself for making such a stupid mistake and wasting insulin that I didn’t really need. Why didn’t I check my inputs before starting my bolus? How could I have ignored my ticking pod as unit after unit of insulin pumped into my body? What kind of idiot does that to herself?

I can’t answer the first two questions, but I can take a stab at that last one – the kind of idiot who is a human who’s had diabetes for most of her life and errs from time to time, just like any other human being with or without diabetes.

Sure, I was furious with myself for screwing up like this, but all things considered…it was bound to happen eventually. We all make mistakes and it’s impossible to double-check every action taken in life. I’ve had some time and space to process this incident, and I’ve forgiven myself for this reason coupled with the fact that I’ve never done anything like this before in two dozen years of life with diabetes. That’s a significant amount of time to go without an incident like this!

Plus, with that forgiveness comes the value of an important lesson learned, which is to be more mindful when I’m taking a bolus. It’s so easy to mistype something on a computer keyboard or when texting someone and this scenario is no different from that. I need to be better about being my own autocorrect, but balance the weight of that responsibility with the knowledge that I’m a human who is managing diabetes 24/7, which is exhausting, and that perfection is a myth.

Major diabetes mistake made, lesson learned, and time to move onward and upward.

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

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

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

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

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

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

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

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

How Long Do AAA Batteries Last in an OmniPod PDM?

How long do AAA batteries last in an OmniPod PDM?

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

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

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

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

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

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

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

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

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

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

PDM System Error: What It Is and What to Do When It Happens

I crack open the slot on the back of my PDM where two AAA batteries are nestled. I smack them out from their slots, insert two fresh ones, and replace the cover. I wait for the system to power back on and am greeted with a high-pitched beeping sound soon after it’s reactivated…

…and become simultaneously annoyed, confused, and a bit panicked when I see a “system error” message displaying on the screen.

I follow the steps that flash on its display, instructing me to reset the date and time. Once I take care of that, my pod immediately deactivates, aggravating me further. I assemble all the supplies I need to activate a new pod, and once I have it on, I receive a message that I won’t be able to use the bolus calculation function on my PDM for 3-4 hours.

The whole incident was majorly inconvenient, but such is life with diabetes…

Anyways, if you’re like me, you’re probably wondering what exactly happened, and why it triggered my pod to fail.

Error messages on diabetes technology are never something I’ll be glad to see, but they do happen.

Fortunately, I can explain it!

I’ve experienced this phenomenon before – it happens when the internal battery within the PDM (not the AAA batteries) has a problem and stops working the way it should. It causes the system to get confused when new AAA batteries are inserted (because the system shuts off and turns back on) and it doesn’t remember the date or time. Because of that, it can’t identify when the current pod was activated, so it immediately triggers it to stop working so new one can be applied.

It’s obnoxious as heck because it’s a total unpredictable phenomenon, but it is what it is. It can be dealt with in a matter of a few hours, and the best part is that Insulet can be contacted so they can be made aware of the issue and overnight a new PDM – which is what they did for me. The day after this PDM problem occurred, I gave them a call, and within 10 minutes I was promised a new PDM that I would receive in about 24 hours.

So when a PDM system error happens again – not that I actually anticipate it to for a long time – I know the right course of action is to keep calm, follow the system’s instructions, and give Insulet a phone call. In other words? Rolls with the punches, because diabetes is good at directing them my way.

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.

What the…BEEP!

Beeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeep.

A long, unfaltering, high-pitched beep was emitting from something in the pharmacy. I saw heads turn in the vicinity as fellow customers, as well as myself, tried to identify the source of the noise.

I gulped. Could it be coming from me? Did my OmniPod fail right then and there as I was picking up my prescription?

WHAT THE...BEEP!
I wish an image could accurately portray just how annoying the beeping sound can be.

I anxiously dug through my backpack, my fingers searching for my PDM, until they met it. I pulled it out and prayed that all was well, that my pod was working as it should be.

A quick press of a button, and…I confirmed that my PDM and pod were, indeed, working properly. Simultaneously relieved yet still bemused by the noise, I put my PDM away while I scanned the area around me, determined to find out what was making a sound so similar to my OmniPod.

What was the culprit? Well, you know those little plastic boxes that drugstores encase things like razor blades in, to prevent theft? That was the thing emitting a blaring beep, in this situation. And like I’d initially assumed, it was coming from me: I was holding one of those boxes in my hand (because I was about to purchase razor blade replacement cartridges), and I’d unintentionally obscured the sensor that triggers the alarm to go off.

Whoops.

While it was nice to know that my insulin pump hadn’t failed on me, it was still somewhat embarrassing to discover that I was the cause of the ruckus, anyways.

Lesson learned: Keep those protective plastic cases in plain sight so I won’t have to misidentify what the beep is coming from.

My New PDM

After four years filled with various highs and lows, I had to say farewell to the PDM that was virtually glued to my side, working with me to manage my diabetes.

Our parting was inevitable. Around the Fourth of July, I noticed that the battery symbol on my PDM was low, meaning that the triple A batteries within needed to be replaced. I put fresh ones in, but upon the system restarting, the PDM asked me to input information such as the date and time. And then…the pod I’d been wearing for less than 24 hours beeped loudly, signaling to me that it had failed. I figured it must be due to the battery replacement, but this definitely wasn’t normal. So I did some investigating.

I consulted with my mom and she told me that this was a sign that the internal battery within the PDM, the one that cannot be replaced, was starting to run out of life. She advised me to call Insulet to get a replacement PDM. That’s how I discovered that the warranty on my PDM actually expired in January of this year, and that I’d have to pay a nice chunk of change (about $500) to get a new one, under warranty.

It was a painful process, as I’ve detailed in recent posts, but I finally did get my new PDM. Fortunately, it only cost me $100 (I guess I should be glad I met my $900 deductible so quickly).

My New PDM.png
A very special delivery.

I waited to power up the new system until I was due to change a pod – didn’t want to waste a pod if I didn’t have to – and I’m really glad I set aside a half hour or so in order to input all of my settings into the new PDM. It was a bit stressful, really, and just as I was cursing the PDM for not automatically knowing all of this stuff about me, it was set up and ready for action.

It was a strange feeling, disconnecting myself from that PDM I’d relied on for four years. It sounds dramatic, I know, but that PDM and I have been through a lot. As I powered down the system, I had a little moment and felt gratitude toward the PDM (and I suppose all of its little quirks). I put it inside the box that the new one arrived in, and the old PDM now sits in my diabetes supplies cabinet, neatly tucked away so in the event that I need to consult it for old information or data, I can.

And now I can say I’ve got a shiny, pristine PDM that’s under warranty, which I must admit is a relief.

Doing Everything Right and Still Getting it Wrong

One of the most frustrating things about having diabetes is feeling like you’re finally understanding it, perhaps even mastering it, only for it to lash out at you and make you feel like you don’t know shit about it.

It’s when you do everything right – check and treat accordingly, eat properly, exercise sufficiently – and still get it wrong when your blood sugars don’t behave the way they should.

I really hate when this happens, but I loathe when it happens on vacation…which is exactly what happened to me last week when I was in Maine for a few days.

Things started going awry shortly after I woke up (if only I knew then that I was in for a DAY!!!). I ate breakfast and my blood sugar swiftly started to rise. But I didn’t panic, because that’s what I wanted to happen. We’d be walking all around town for part of the morning and most of the afternoon, so I wanted my blood sugar to be on the higher side so that my chances of dropping dramatically in the heat were lower. I made the right call – soon after we got downtown, I noticed a diagonal down arrow on my Dexcom app. Things were headed in the right direction…or so I thought.

Not long after I spotted the diagonal arrow, I started to feel a little low-ish. Not super shaky or anything, but just a bit disoriented. I decided to pop into my favorite candy store to fill a small bag with treats so I had something sugary to munch on that would prevent a bad low blood sugar.

Those were mistakes number one and two…not consulting with my CGM again before eating candy, and going to town on it because it was CANDY and it tasted delicious.

Doing Everything Right and Still Getting it Wrong

Within a half hour, I was rising up, up, and up. I took a small amount of insulin to correct it, not wanting to be too aggressive and risk a real low. But as I walked around the amusement park with my boyfriend and his family, I just wasn’t coming back down like I thought I would. I lingered in the mid-200s for much of the early afternoon, and by the time we stopped for lunch, I was rage-bolusing to bring my numbers down faster. I even chose a lower-carb lunch option in the hopes that it’d stave off another high blood sugar, but nope, the BG gods were not in my favor that afternoon. As we moved from the amusement park to a brewery (a drastically different change in locale, I know), I bolused once again, and then noticed that the batteries in my PDM were low.

And that actually wasn’t a problem, because I was prepared enough to have spare triple A batteries on me – thank goodness! I took the old ones out, popped the new ones in, and waited for my PDM to come back to life. And it did…but it asked me to input the month, day, and year.

Dammit. THAT’S never a good sign. I entered the information and the system accepted it, and then my pod failed immediately after, which meant that I had to ditch the brewery and the group of people that I was with to get back to the house we were staying at as quickly as possible to put a new one on.

It doesn’t get much more irritating than that.

(Later, I discovered that my PDM’s internal battery was going, and that this behavior would occur every time I replaced the triple A batteries. Needless to say, I’m awaiting a new PDM from Insulet, because it’s just not smart to continue using an aging PDM.)

By the end of this day of turbulent blood sugars and unpredictable medical device malfunctions, I was mentally beat. I felt like I’d been thrown into the roughest of ocean waters and forced to tread water for hours in order to keep my head above the surface. It’s exhausting to know that, when it’s all said and done, I was really trying to do the right things and take care of myself. I was SO DANG PREPARED with those extra triple A batteries, for goodness’ sake! But man, diabetes…just when I think I know it better than anything else, it throws me for a loop and I remember a saying from Professor Mad-Eye Moody of the Harry Potter series (of course I’m talking about Harry Potter again, don’t act surprised): CONSTANT VIGILANCE. I’ve got to be aware of my diabetes at all times. I’ve got to know how to react and when so that my diabetes will remain in my charge – not the other way around.

How to Change an OmniPod

I decided to do something a little different and take video of how to change an OmniPod. Rest assured, though, that it does not take 22 seconds – it’s more like a seven-minute process.

Some things you’ll notice about my process:

  1. I fill my syringe with insulin and set it aside before deactivating my old pod. This simply means that I wear the old pod a little bit longer so there’s less of an interruption in time that I go without insulin.
  2. I use a pen to smack bubbles out of the syringe. Air bubbles will inevitably develop when drawing insulin out of a vial, so I find that gently hitting the sides of the syringe with a pen is the most effective way to get rid of the pesky air pockets.
  3. I prep my site with an alcohol swab, followed by a skin-tac wipe. The alcohol merely cleans the site, whereas the skin-tac makes the pod adhere to my skin better and longer.
  4. The new pod activates best when it is adjacent to my PDM. I always place my new pod to the right of my PDM. This helps the PDM register the new pod.
  5. It doesn’t actually hurt when I rip off an old pod. Not sure if you detected my dramatic facial expressing, but I was just yukking it up for the camera. It truly doesn’t hurt, especially if you just remove it in one swift motion.

So that’s it, the full process boiled down into 22 measly seconds. I admit that I kind of had fun making this video, even though the sight of myself sans make-up is semi-horrifying. But give me a break, I was on my way to a Pilates class! And let’s be real, diabetes isn’t always glamorous.