Transmitter Timelines

I wrote a few days ago about the fact that my Dexcom transmitter battery was on its last legs. Rose had alarmed early on Saturday morning and screeched 'low battery, replace transmitter soon' to which I muttered 'great timing' as I headed off for my morning brick workout.

Rose's alarm went off at the beginning of a long weekend which means that I could not order a new transmitter until Tuesday. Which meant that the earliest it would arrive would be Wednesday - five days after Rose's alarm.

I've only had to replace my transmitter once and, that time, I had already ordered a new one because I was worried that mine would die and didn't want to be without. These things are supposed to last about six months but when you consider that I've been using the Dexcom system now for 20 months and, until Saturday, had only replaced the transmitter once, I'd say I was doing quite well.

So my problem was that I had no idea how long I had once Rose alarmed. Hours? Days? Weeks?

I called Animas first thing on Tuesday to order a new transmitter. My old one, up to that point, was still working fine.

While I was on the phone I asked them how long I had once the alarm went off.

The person on the other end hemmed and hawed for a few moments before saying 'we really just don't know so you should order it as soon as you get the warning'.

"As long as it's not the Saturday of a long weekend' I replied.

On Wednesday morning, Doug and I went out for an early morning bike ride. It was rather cool out which is notorious for draining batteries. When we returned home I saw that two alarms had gone off. Basically I was told that my transmitter had completely died but, not to worry, my pump was still delivering insulin (whew!).

I removed the transmitter and, with a rather large feeling of guilt, tossed it into the garbage. It had lived a relatively long and productive life but the thought of tossing something that costs $700 into the trash is rather nauseating. Thankfully I have coverage but I am still very aware of the cost of these things and do my best to drag them out as long as possible.

I headed off to work with my glucometer in my purse. After almost two years on a continuous glucose monitor, I was flying blind and might be for a few days depending on how long the new transmitter took to arrive. Instead of being able to see my blood sugar every five minutes (if I want to) by looking at Rose's screen, I was back to relying on feel and hourly finger pricks. Not nearly as reliable.

Around 11am, Doug texted to say that my new transmitter was sitting on the kitchen counter. Thank heavens! I can of course survive with only a glucometer but I've come to rely on the reassuring presence of a continuous glucose monitor and I felt vulnerable without it.

I'm all connected again and ever so grateful for all my cyborg parts. Hard to believe that I once refused to consider an insulin pump or a CGM. Now I can't imagine life without them.

Triathlon Trepidations

The summer of 2013 was a big summer in terms of triathlons. We did four of them. And I learned all sorts of things about triathlons and blood sugar management. So much so that I hardly thought about it by the end of the season. Kinda like how I handle long runs. After having done so many of them, I just know what I need to do.

Well after a summer off, I'm feeling decidedly out of practice in the triathlon department.

Thank heaven's I have a little book where I write things down. Like basal rate settings for every triathlon I did in 2013. I have a schedule that is broken up into 30 minute segments from 5am until 2pm, that includes timing for breakfast and snacks and bolus percentages for each, basal rates (by percentage and actual amounts), and a summary of how well it worked in case I forgot (which I did).

It's kinda like trying to read Spanish. I know enough to make out the message but wonder if I'm missing any of the subtleties.

So I guess I'll be programming my pump tonight with a race day basal profile. I'll be trusting my report from two years ago because I have nothing better to go on. I must admit that I'm feeling decidedly out of practice. I've only been back in the pool for a few weeks, I have only had one long bike ride and I just ran a half-marathon 5 days ago and my body is tired.

The good news is that I have a continuous glucose monitor (CGM). Two years ago, I had nothing of the sort so I had to rely on blood sugar checks in the transition zone. Now, other than during the swim where the CGM doesn't work, I'll be able to see what is happening before, during and after and Rose will warn me if I'm high or low. There is a comfort in that.

Come back on Monday and you can hear how it went. I don't expect to have many, if any, photos because Doug won't be out there supporting me this time. He'll be out there swimming, cycling and running with me. But I'm sure I'll have some stories to share and some lessons that we can all learn from.

When in Doubt, Trust the Feeling

Yesterday I wrote about having faith in diabetes systems, even when they do not always work.

Well, on Saturday, I ended up having to have faith in my ability to feel what my blood sugar is doing rather than relying on technology to keep me safe.

I have been using a Continuous Glucose Monitor now for about 18 months. When I put a new sensor in, the first day readings can be a little wonky and when the sensor starts failing, two or more weeks later, the readings can also be a little bizarre. But from the second day until the second week, it's usually extremely accurate. So much so that I will often  treat highs and lows based on what the readings say

So on Saturday morning, when I headed out for a run with my 3-day old sensor, I had complete faith in the numbers.

I was 6.0 before the run. Since I was only (only!) running 10k, I had one date. That should have been plenty.

At the 5k mark, I did a quick check and discovered that Rose was buzzing to tell me that I was 3.8. I didn't feel 3.8 and I should not have been 3.8 but there it was, flashing on the screen. To be safe, I had a package of fruit chews.

I started running home. A few minutes later, Rose's ear-splitting siren alarm went off. The alarm that goes off when I'm under 3.1. It made no sense. I sure as hell did not feel 3.1 but, because she was telling me I did, I started feeling like I might be 3.1.

I refused to eat another package of fruit chews. I knew that one package should be enough and two packages would send me flying high in no time. So even as she kept alarming to tell me that I was 2.8, then 2.4, then 2.0 and then just plain "low", I kept running.

When I got home, I did a finger prick and discovered that I was 5.6.

I knew it!!

I re-calibrated Rose and, for the next 5-6 hours, she behaved herself.

Then, as we were sitting on the couch after a busy day of yard work, I started feeling low. I checked Rose and she said I was 7.0 and holding steady. And she had been accurate an hour before so she should be fine.

A few minutes later, I couldn't wish that low feeling away. I went to the kitchen and a finger prick told me that I was 3.8. Rose still said I was a lovely 7.0.

I had some maple syrup for the low and I shut down my 3-day old sensor. I waited an hour and then I restarted it. Two hours later, it was ready to go and I calibrated it.

Rose has been fine every since.

My Diabetes-Fighting Team

Dexter has been in my life now for 14 months. Rose has been around for 9 months.

Together, the three of us make a great diabetes team. Not that we do actual battle with diabetes but we sure do work together to keep him in his corner.

As soon as he starts acting up, Dexter takes notice and sends out a bat signal.

Rose spots it and starts vibrating to pass along the message and then I step in with my bag of tricks (insulin, emergency carbs, water, exercise and a voodoo doll) and together in our slapstick way we bring things back to the way we like them.

We slay the vampires so to speak.

 I like to pretend we're like this trio - only a little more 2015ish. I keep flip-flopping between whether I want to be Willow or Buffy. I'm leaning towards Willow. And Rose is totally Buffy in her fancy pink coat. 

Anyway, so the three of us make a great team. 

Which made it all the more disconcerting when things started to go wrong last week. I was at day 9 of my sensor and things were fine until I got out from the shower last Wednesday morning. Instead of seeing my blood glucose number on Rose's screen, I saw the dreaded ??? instead. 

I hooked her back up anyway and crossed my fingers. About two hours later, she buzzed to tell me that my blood sugar was 3.9 (which it was) but it took two hours for the ??? to go away. 

The next day, it happened again. Right after my shower. And about two hours later, everything was fine. That night, I changed my CGM sensor hoping that was the problem. 

The following morning the same thing happened. It happened on Wednesday and Thursday with my old sensor and it happened on Friday, Saturday, Sunday and Monday with my new one. Each day was the same pattern. Something was happening in the shower that messed things up. 

Since not showering was not an option, I really needed to figure this out. 

So, on Monday, I called Animas Tech Support and found myself speaking to a nice guy in California. He walked me through some of the things that it could be and none of them seemed to fit. He explained that seeing ??? meant that the sensor was reading my blood glucose but could not make any sense of what it was reading. Which eliminated the possibility that it was a transmitter battery problem. 

He said that it could be a problem with the back of the transmitter getting wet during my shower but we both agreed that was odd considering it never happened before and now it was happening every single day. Plus, I added, when I go swimming for 90 minutes, I never experienced any problems with Dexter finding Rose again afterwards (I didn't actually use their names for the record). 

He finally concluded that I may have simply had two faulty sensors and he agreed to send me two new ones immediately. 

Hopefully he's right. 

I don't like it when Dexter sends a bat signal and Rose isn't able to read it. It kinda freaks me out. 

I spent the first 10 1/2 years with diabetes flying blind. Relying on finger pricks to keep my numbers in check and going to bed every night crossing my fingers that I would wake up if I had a problem. 

I've come to rely on my CMG and the feeling of security that it brings. Missing that for 2 hours every morning, particularly right after breakfast and a run, is really disconcerting. 

A Month of Numbers

I was cleaning up my home office on the weekend and spotted my Diasend box of tricks amongst the piles of documents that I needed to file.

So, while I filed, I uploaded a month's worth of insulin pump data.

Once I finished filing, my treat was that I got to pour over the numbers, cup of tea in hand, to see how things had unfolded in the last month or so.

The number of ways that Diasend lets me look at the data is almost too much. The first few times I did looked at it, I looked at everything and got too bogged down in the details to notice the important stuff.

Now that I'm a little more experienced, I look at the things that are important.

Like this:

A month's worth of Continuos Glucose Monitor (CGM) readings. The green section is my target range (between 4.0 and 10.0). The red dots are my average reading for every hour of the day. The black lines extending up and down from those dots show the highest and lowest reading I had during each hour. 

And this:

This pie graph is my favourite thing to look at. It tells me at a glance what percent of CGM readings were below 4.0, above 10.0 and what percent were within target range (4.0-10.0). According to this I was below 4.0 only 3% of the time and above 10.0 only 16% of the time. The rest fell into the lovely green section. 

The last thing I look at is a tiny little number on the last page that read: average blood glucose reading. 

For the last four weeks, my average blood glucose reading was: 7.5 

So what did I do after checking out all the stats? 

After doing a happy dance I mean. 

I increased my basal rate between 11:00 and 17:00 to try to get those higher afternoon numbers down a bit. I also made a minor increase in my insulin to carb ratio at lunch time to see if that will help too. 

Other than that, I'm not touching anything. No point messing with a good thing. 

85% isn't so bad

Can you define healthy?

What does it really mean to be healthy?

That your blood test results come back in the acceptable range when you are tested for cholesterol, vitamin b12 levels, A1C and other things?

That your blood pressure falls in the acceptable range?

That your BMI falls in the acceptable range?

That you can run to the corner and back without collapsing? That you can run a half marathon?

That your colour looks good?

That you don't have dark circles under your eyes? That your hair is shiny? That your nails aren't brittle?

That you eat a variety of fruits and veggies every day as well as grains and legumes and kefir and chia seeds?

That you don't smoke? Or drink too much? Or overdo the caffeine or the salt or the sugar?

That you get enough sleep? Or that you don't get too much?

Is healthy about what you do?

Or what you don't do?

Or what the blood test results, the blood pressure results or the BMI results say?

I have been thinking lately about all the things I try to do to be healthy. And all the things that I don't do in order to be healthy.

I was wondering which choices have a greater impact. Does staying in bed an extra 90 minutes make more sense than getting up super early in order to exercise before work? Does sticking to one coffee a day and then switching to herbal tea really make a difference in the great scheme of things?

And does my body know how many times I crave chocolate and yet don't eat it and does that knowledge somehow help justify the times that I do eat it? Kinda like buying something expensive on sale and talking about how much you saved rather than how much you spent?

The other day I downloaded two weeks worth of readings from Rose. Insulin information, continuous glucose monitor information. Basal changes and bolus correction information. I then spent a good amount of time looking at the 40+ pages of information that was generated. I was able to look at every minute of every day to see my blood sugar highs and lows. I was able to look at charts and graphs and everything I looked at seemed to point out all of the times that my blood sugar was below 4.0 or above 10.0.

All I could seem to focus on what the times I was high and the times I was low.

And then, on the last page of the report, there was a lovely pie chart. This pie chart summarized beautifully what percent of the time my blood sugar was below 4.0, above 10.0 and between 4-10.

The results:
below 4.0 = 5% of the time
above 10.0 = 10% of the time
between 4-10 = 85% of the time

I don't know what you think but the fact that I am hanging out between 4-10 85% of the time is pretty damn fabulous in my books.

I think it's too easy to feel bad about the unhealthy choices that we make. The big ones and the little ones. It's easy to feel guilty about having that chocolate bar or going to bed too late or not getting up to exercise before work.

And I think it's important to look at the pie chart. Because while we're busy getting caught up in the unhealthy choices we make, we often overlook all the healthy ones.

And those, my friends, should be celebrated!

T-shirt Troubles

There is something odd that happens when running in a t-shirt.

Actually, I should probably clarify that a bit.

There is something odd that happens when running in a t-shirt if you have type 1 diabetes, wear an insulin pump and a continuous glucose monitor (CGM).

And you're me.

The t-shirt running season for me is usually fairly short. In the winter I run in winter running clothes that have nothing to do with a t-shirt. In the early spring I switch to shorts but keep a long-sleeved shirt for a few more weeks. Then it's shorts and a t-shirt but only until it's just barely warm enough and then I switch to my tank top that I wear all summer. Then reverse everything I just wrote as winter rolls back in again.

Last spring, I wrote about how running in a t-shirt seems to dislodge my insulin pump site and/or my CGM. I figured it was the back and forth flow of the t-shirt that did it since my tank top and my winter running tops are all snug and don't move. I wrote about how I was having to run home from work to change a leaky infusion site or having to re-tape my CGM back on because it was barely holding on. Then I stopped writing about that during the summer because it stopped happening.

Yesterday morning it was just cold enough that I put on my t-shirt. Not even thinking.

I ran 7k.

By 2.5k, the shirt had rubbed my CGM to the point where it was barely hanging on and no longer saveable. Since it had already lasted 9 days, I was ok with the sacrifice. Anything under 7 feels like a loss but anything over feels like a win. Still though, 15 minutes of running and my CGM, complete with extra adhesive, fell right off? That won't do at all during long runs and races when I rely on that to tell me what my blood sugar is doing.

I got home, tested my blood sugar and prepared to bolus for breakfast. At the last second I remembered that my site would often leak after running in a t-shirt to I lightly pressed a tissue against it while the insulin went it. I pulled it away afterwards and there was a tiny wet spot that smelled suspiciously like bandaids (insert bleh noise here).

I decided to push the infusion site rather than change it too and it did well all day - no unexplained highs but it did leak a bit with each bolus.

Surprising what one 7k run will do when there is a t-shirt involved. It cost me an $80 CGM site and almost another $20 infusion site. I should take that money and see if I can find a t-shirt that fits like my tank top.

Because I've been reminded that the t-shirt thing just doesn't work for this type 1 gal.

Stymied Sensor

Yesterday's blog whipped through the weekend rather quickly because that was all I had time to write. Now that I have a few more minutes, there are some things I would like to revisit. Specifically in the diabetes department.

I've been working at figuring out how to keep my blood sugars fairly stable while I play golf. Golf is different than swimming or running and, as a result, I'm learning all over again. There are a few diabetes challenges when I play 18 holes.
a) I'm doing 4 hours of walking and carrying golf clubs so it's a lot of low intensity exercise which I'm not used to doing.
b) It's usually really hot out so dehydration is always a risk
b) I get hungry and need to have a snack partway through. If I don't I'm a shaky mess by the end that has nothing at all to do with diabetes. I'm just beyond hungry.
c) I don't want to take insulin if possible on the course because, in combination with the activity, it usually leads to a yoyo of lows and highs that involve me eating way more than I want and feeling sick or not being able to eat even when I'm starting.

After a bit of trial and error I've worked out a system that seems to be effective. I don't do it when I play 9 holes but I do when I play 18.

(This is where I add the reminder that your diabetes may vary and my experiences are my own.Add to that the fact that I'm not a doctor and you'll realize that doing exactly what I do is probably not the best way to handle your diabetes. If you even have diabetes.I guess I should add that your golf may vary too so don't be copying my golf technique either)

I lower my basal rate by 40% 90 minutes before we start. I set this temp basal for 4 hours which means that my regular basal rate kicks in before the golf game ends. I do my best to make sure my blood sugar is mid-range (6-8) before I start and that I have no insulin on board from a previous meal. I have a small snack before we head out (ex. a banana or an oatmeal cookie). No insulin for the snack.

I check Rose after every hole to catch highs or lows before they happen. Once we finish 9 and confirm that we are indeed doing all 18, I will have a Clif bar. If my blood sugar is hovering a little high (10+) I will have half the bar and if it's a little lower (under 8) I'll have the entire bar. No insulin.

The carbs in the bar do battle with the exercise in my legs and it usually results in my staying between 6-9 for the back nine.

On Sunday, I got to test this system on faith. I lowered my basal insulin as usual. I was 6.9 at the start of the 10th hole so I pulled out my Clif bar and ate the entire thing. I teed up and hit my ball. My shirt which was rather sweaty from the heat twisted against my side and I felt my sensor pull out as I hit the ball. I mean entirely out. I lifted my shirt and it was hanging there limp and unusable. I did not have my glucometer with me because Rose is so consistent that I never need it on the course.

Option 1. End the game.
Option 2. Trust my system and my ability to sense when I'm high or low and carry on.

I carried on of course. I felt fine the entire way. I made sure to drink a lot of water to help avoid dehydration-induced highs and I kept checking in with myself to see how I felt. We finished and I guessed I was 8.5. I was 9.0. Perfect.

By the time we got home and I showered, it was 8pm. If I put in a new sensor I would have to wait two hours to calibrate it and I knew I was too tired to stay up that long so I went to bed without a sensor. Probably the second time I've done that since last November. I used to sleep without a backup system all the time but, now that I've gotten used to it, it's a little disconcerting to think that the only thing that will wake me up if I'm low is me.

I checked at 1am and I was 9.6. I took a modest correction bolus and woke up at 6:30am with a lovely 5.0. By 9am my new sensor was up and running and the comfort of being able to look down and see how I'm doing was back.

It's nice when the diabetes gods play nice.

Analyzing Diasend Trends

A week and a half ago I wrote about the excitement I felt when I discovered that I could upload data from Rose to a website called Diasend. 

I talked about how I could analyze the data to my heart's content - looking at daily, weekly, bi-weekly, monthly or even 90-day trends in blood glucose data, insulin data etc etc etc. 

I posted a few graphs from my original upload. Like this one: 

This was a graph showing my blood glucose readings over a one-month period. My average (the red dots) at every hour of the day fell in between the high (10.0) and low (4.0) blood glucose ranges I aim to stay within which made me happy. I didn't drop much below 4.0 when I did go low which was good but I was not particularly pleased to see how high I my blood glucose numbers went some days. 

After seeing that graph, I made a few adjustments to my basal rates. I increased them starting at 5:00pm until about 4am. I didn't increase them by much. Just enough, I hoped, to get those highs a little less high without causing more lows as a result. 

On Saturday, I uploaded data from the past 9 days from Rose to Diasend. Here is what the last week looked like. 

If you compare with the first graph you'll see that the red dots are still in a pretty good range (not too high - not too low). The highs I was having late at night and in the early morning have decreased.  

I have gone lower than I would like around the 2am mark as well as around the 5:30pm mark. The afternoon one shouldn't have anything to do with my original basal changes but I'm keeping an eye on it. I may need to lower my afternoon basal rates a bit. 

So I made a few more tweaks and have increased my overnight basal just a bit. Not back to where it was before but probably half way. 

Let's see what this next week holds. 

Double Arrows and a Lotta LOWs

I put in a new CGM sensor yesterday morning at 8am. Zombie Rose had lasted 17 days and then, without warning, died a final death on the bathroom counter. So I put a new one in and, at 10:00am, Rose was buzzing away telling me to enter two blood sugars to calibrate.

I did and went back to work at my desk.

I have heard rumours, or perhaps rumblings. that the first day on a new sensor is not particularly accurate. That it takes a day or so for the sensor to 'marinate' as it were before the numbers are a little more reliable.

I've only ever experienced wildly inaccurate readings on the first sensor day once. They were all over the place - telling me I was climbing or dropping when I wasn't. Telling me I was 5-6 numbers off from where I was. I Things did settle after a while but, as it turns out, it's actually more annoying to be told wrong blood sugar numbers than to not actually know your blood sugar numbers.

Yesterday was one of the craziest crazy rabbit blood sugar days I've had in a while.

I calibrated the new sensor at a time when my blood sugar should have been fairly steady. I think it was pretty steady at 10am but, at about 11am, the wheels fell off the cart. Between 11am and 7pm (when I'm actually writing this blog) I had double down arrows 3 times. I dropped below 3.1 twice. I skyrocketed to 13 and then dropped back down to 2.7.

I kept double checking my numbers on my glucometer and, despite all of the ups and downs, Rose was pretty accurate. Particularly on her first day.

I kept thinking it was just her but no, I really was riding some pretty wild waves.

So much so that, for the first time in living memory, I had to sit in the car for 20 minutes after doing groceries to let my blood sugar climb above 5 so I could drive the five minutes it takes to get home. My blood sugar hit 5 and I started the car. Within five minutes I had double up arrows telling me I was 7 and then 9 and then 11. Twenty minutes later I had double down arrows that didn't stop until I hit 3.0 again.

During that particular wave I had no insulin in my system other than my basal rate. It is not the first day of my period which is the typical cause of such wild fluctuations. I did not eat anything out of the ordinary. I was not stressed or getting sick. I had not done any unusual physical activity.

I've gone back to swimming regularly but does it make sense for my body to react to that increase in activity by having lows after I've been swimming 5 times?

Rose at 7:30 last night. Double arrows again. You can see in the middle where I dropped so low she kept alarming "low" without actually give me a number. That's when I sat in my car munching on glucose tabs and hoping my frozen fruit wouldn't melt before I got home. Then you can see where  I spiked up to 10 within fifteen minutes only to drop back down to 3.1. 

It's frustrating. I've eaten three healthy meals today as well as about 500 calories of pure sugar. Fabulous.

I dropped my basal rates at bit to see if that helps. Yesterday might have been just a fluke but I sure as hell don't want to do that again any time soon. I'm sure Rose doesn't either. It can't be fun to have to vibrate so much or to set off the 'you are below 3.1' siren in public places. I'm sure it embarrasses her as much as it does me.

Right Rose?

Wednesday W'oundup

I was feeling a little bullet point-ish when I sat down to compose Wednesday's blog so here is my Wednesday W'oundup for y'all.

- I swam 10x100m on Friday morning. Eight of ten of them were done in exactly 1:47.

- I swam 10x150m on Monday morning. Despite pushing hard on some and feeling slow on others, eight of ten of them were done in exactly 2:47. Consistent much?

- When Dexter was a big part of my life (I miss his cute little smile so much!), I had a special name for him when I resurrected him after 7 days. Zombie Dex was his nickname when he woke from the dead on command. Now I have Rose who is a little more dainty - although she can be a tough cookie when she needs to be. She is currently 15 days old which means she's been resurrected twice. What do I call her? Zombie Rose? Seems a little too unladylike for the wee lassie. How about a tribute to Zombies? I could call her Buffy? Or Willow?

- 18 days ago I got my nails done for Friends for Life. At my mother's suggestion I decided to try bio gel nails and then, instead of regular nail polish that chips in two days, I went with the super duper  shellac nail polish that is supposed to last for weeks. Well, 18 days later my nails look the same as they did the first day which is amazing considering they have survived hours of chlorinated water as well as the general banging around that my nails undergo every day. The only problem is that they are growing out and there is now a few millimetres of bare nail growing in. Now I need to figure out how to safety remove said bio gel nails with shellac before I end up gouging my or someone else's eyes out accidentally. These puppies are getting loooong.

- Doug took me to the golf course on Monday night to practice. Practice my chipping and my putting. I probably hit 100+ chips and putted close to that much again. I got pretty good by the end.

- Doug took me to the golf course on Tuesday night to play nine holes and practice what I practiced. I played really well on 6 of the holes. I played horribly on three of them. My score ended up the same that it always is. Consistent much?

- I just finished the latest book in the Outlander series. For anyone who knows what I'm talking about and who has also read said book, please tell me. I'm desperate for someone to hyper-analyze the book with. So many things happened. So many things to agonize about. And who is excited for the season premiere of Season One? Anyone??

- My ear buds finally bit the dust a few weeks ago. I am on super budget mode as we save for a trip this fall so I am only spending money on thing I need (like bills, groceries and toothpaste). Earbuds don't fall in that category so I've been running to the beat of my panting breaths and pounding feet. It was weird the first day. Less weird the next. Now I really enjoy the quiet.

That's all folks. See you tomorrow!

Rose the Swimmer

Yesterday I wrote about Rose's heroic feat during her first half marathon. How she kept accurate track of my blood sugars despite the activity, the heat, the humidity, the dehydration and the sweat.

And yesterday, in response to my post, my friend Jeff asked me how Rose performs when I swim. Does she still achieve such stellar results in the pool?

I was going to respond to him directly but then decided that other people might be interested in what I had to say. So that is the topic of today's post.

Rose is a wonderful sidekick on runs but how does she do in the pool?

Well, not very well as it turns out.

The way Rose works is like this. I have a continuous glucose monitor sensor attached to my abdomen somewhere. I move it every 7-14 days. My pump, Rose, is usually attached to my belt or, when I swim, to my bathing suit.

The sensor takes a read of my blood sugar. Rose and the sensor communicate every five minutes and my blood sugar numbers show up on a graph on my pump.

If I left Rose on the kitchen counter and sat on the living room couch, she would still register my blood sugar numbers.

She does well over reasonable distances...unless there is water involved.

I've only worn her a few times in the pool so far but, every time I did, she lost the sensor signal almost immediately and didn't find it again until I got out of the pool.

As soon as I was in the water, Rose and the sensor could no long communicate. She would vibrate every 30 minutes to let me know she had not found a signal in half an hour. And then as soon as I got out of the pool, she would find it again. I didn't have to dry off, I just had to get out of water.

So my dream of being able to see my blood sugar in the middle of an open water swim are not going to materialize. But I'm happy to know that, as soon as I'm out of the water, she's good to go. That will make a big difference during triathlons and help me keep on top of my blood sugar on races days.

Rose's First Half Marathon

Yesterday I wrote about the half marathon. I wrote about the support I received from friends and partners. I wrote about the heat, the port-a-potties and the finish line chocolate milk.

What I didn't write about was Rose. My two-week old Animas Vibe insulin pump. The one with the fancypants continuous glucose monitor built right in. I didn't mention her yesterday because I figured she deserved an entire blog all to herself.

Rose was not in my life during most of the training for this race. As a result, we didn't have time to practice together and I did not know how she would react to blood sugar changes during long bouts of running. I did not know how she would react to running in the heat and sweat-drenched sensor sites. Or less than ideal hydration levels.

Here is what my race-day diabetes adventures looked like.

I woke up at 5am for an 8am race. I immediately tested my blood sugar and the glucometer reading was bang-on with Rose's number. I took a full bolus for my breakfast. I wanted the breakfast insulin to be out (or mostly out) of my system before the start of the race and I wanted to take a full bolus so that I wasn't  starting off with high blood sugars. I figured it would help combat the pre-race adrenaline spike too.

I waited 25 minutes before eating and I watched my number slowly drop from 8.5 to 5.5 during that wait. I ate breakfast and then stalked Rose to see what was happening. I climbed up to 9 and then settled back down at 7.8 by 7:45am. I had a gel and headed for the start line. At that point, I figured Rose's responsibilities were over. I could not trust her readings during the race and had asked Doug to meet me on the course for some good ol'fashioned finger prick blood sugar testing.

He agreed to meet me at 7k and again at 14k which broke the race up nicely into thirds.

At 7k my glucometre said I was 7.2. Rose also said I was 7.2. I was impressed. I had a pack of fruit chews and carried on.

At 14k I was 6.3. Rose said I was 6.5. I was more than impressed. She was keeping up despite the heat, humidity, sweat and activity. I had a second gel and ran the last 7k to the finish line.

At the finish, I tested again and was 6.2. Rose said I was 6.7.

Seriously folks, for anyone who hasn't struggled with a continuous glucose monitor that doesn't handle exercise well, you have no idea how wonderful this was. Wonderful because I could rely on Rose's numbers but also wonderful because I knew I could trust the graph she provided that showed what my blood sugar was doing between finger pricks.

Rose kept up her stellar work all day. I kept waiting for the wheels to fall off so I did regular (hourly) finger pricks all afternoon. She was bang on every time. Which meant that, by the time I went to bed, I had every confidence that she would wake me if I had a post-race 3am low.

She didn't wake me.

Because I didn't have one!

I slept like a rock all night and woke up to a lovely 4.6.

Thanks Rose!

(Almost) Naked Shower

Yesterday I just missed having my second naked shower since November. 

One in six months. That's just sad when I think about it.

Yesterday morning I went out for an 8k run in the cold spring rain. Dexter, who was already 10 days old and holding on by a combination of sheer determination, the fear of my wrath if he let go before day 10, and some well-placed tegaderm, didn't survive. My wet and heavy shirt kept rubbing on him and, by the end, he had come completely unglued. 

When I got home, I dug him out from under my wet layers, placed him on the counter to dry and headed up for my shower. 

After my shower, I noticed that my infusion site was also barely holding on after the rainy run. There was just enough insulin left in my pump to make it until dinner so I taped it in place, crossed my fingers and went to work. 

I fought highs all day. Not high enough to go home and change my site but high enough to make me think that I may have caused some structural damage to the site and not all the insulin was getting in. 

I changed it the minute I got home and that is when I realized that, if I had changed it in the morning when I was doing Dexter (that sounds worse that it should), I would have been able to have a naked shower. 

Dammit. 

Naked showers, for those of you who get to take one every day, are a luxury that I rarely get to enjoy anymore. 

The thought of not having to gingerly wash around my cyborg parts and just being able to enjoy the shower is, well, I can't even think of the right word for what it is but it's a damn nice thought. 

The thought of not having to think about where and how I stand in the shower so that the water doesn't directly hit one of my sites when the edges are already started to come unglued. 

How many of you actually know how to stand to make sure that some parts of your body get wet but never actually get directly sprayed by the water? How many of you care? I'm guessing it falls in the category of 'who the hell does that?'.

And imagine the whole post-shower drying off process. Dry arms vigourously. Dry legs vigourously. Dry abdomen...oh wait, dab, dab, carefully dab so as not to knock any cyborg parts off. 

Sigh. 

I missed my naked shower by a handful of hours. 

With pump site changes every 4-5 days (usually in the evenings) and with Dexter changes every 8-14 days, the odds of both sites coming off on the same day at the same time just before I need to shower are roughly the same as the odds of my taking up figure skating.

Or ballet.

Or anything else that requires a combination of grace and short skirts. 

Dexcom eh?

Good news! Dexcom is coming to Canada!!

There have already been sightings and it should apparently be ready for wide release by mid-November.

Pretty exciting stuff considering I have read all about it from my US blogger friends who have been using it for years.

What?!?

You don't know who Dexcom is?

First of all, it's not a who. It's a what. Second, it's a CGM which stands for a continuous glucose monitor. In a nutshell, it tests your blood sugar every few minutes and you can see what it's doing by looking at the little screen on the receiver.

Some pictures for those of you who prefer the visuals...

The black beauty on the left is the Dexcom receiver (it also comes in blue or pink). The screen shows the results of the five minute blood sugar checks in a lovely graph complete with colours. On the right is the Dexcom transmitter. 

On the left is the sensor that gets inserted into some part of my abdomen - just like my pump infusion set does. On the right is the transmitter you saw above. It attaches to the sensor, reads the results and sends them to the receiver. Cool eh? 

The beauty of a CGM is that, instead of just testing your blood sugar and getting a random number like, say 5.2, you can also see whether you are 5.2 and climbing, 5.2 and dropping or 5.2 and holding steady. It's pretty amazing stuff and (apparently) makes a huge difference in the way people are able to manage their diabetes. It shows trends we would miss by only doing finger pricks - even overnight when we don't tend to check as often and can miss some pretty dramatic ups and downs.

It can also be set to alarm if your blood sugar is too high or too low.

Let's face it. It's not exactly an iPad mini or a new triathlon watch but, for the role it does play, it's a pretty impressive piece of technology.

I called Animas today and asked to be put on the list of people who are interested. I guess that means I'll be notified the minute the Dexcoms are ready. It also means I was sent information about the costs so that I can contact my insurance company to see what, if anything, is covered.

Gulp.

Like everything else in the diabetes world, the costs are rather shocking:

$800 for the receiver
$700 for the transmitter
$340 for a box of four sensors (Each sensor is supposed to last 7 days. Some, of course, will not come anywhere near that. Others, according to my blogger friends, can be stretched out for weeks with enough care and super stick tape.)

So, the starter kit is $1840 (plus taxes I'm assuming) and then, on average, $340 a month for the sensors.

Double gulp.

Looks like I'll be in contact with my insurance company to see what's what. Once I know where they stand, and after I've appealed every decision that even sounds like a no, I can determine if this is even an option.

Having a CGM would make a pretty significant difference in my life. Of that I have no doubt. But having just paid off a huge chunk of debt, I have no interest in accruing any more. And neither the starter kit nor the monthly sensor cost is in this girl's budget.

As always, I will keep you posted.

To Basal Test or Not To Basal Test?

How many of you out there do basal testing? 

Raise your hand. 

(I'm staring hard into the little camera on my laptop but I can't see any hands up in cyberspace.) 

I've never really done it before. Not in a serious, official, follow the book kinda sense. 

Oh, sorry folks, I should probably explain. Basal testing, for those of you whose aren't pumping, means that you test your blood sugar frequently over a certain period of the day (say from 6am until 6pm) to see if it remains stable. If it is stable, that means that your basal rates are correct. If it goes up or down by any great degree, your basal rates are off. The kicker is that you can't have any carbs during that time period so your meals would look a lot like the Atkins diet. 

My kind of basal testing goes sorta like this: 

5pm - early dinner. 

9:30pm - blood sugar check. It's at a good number (say 6.5). 

Go to bed. 

Get up to pee around 3am. Check blood sugar. It's 6.2. Cross my fingers that basal rates are good and don't eat anything. 

Wake up at 5:15am. Check blood sugar. It's 6.5. Yay, nighttime basal rates are good. 

Yesterday I ate lunch at noon. At 3pm I checked my blood sugar. It was 5.9. At 4pm I checked again. It was still 5.9. I checked again at 5:30pm. It was 4.3. 

My basal rate might be a tiny bit high but then it was dinner time and I had a greek pasta salad and bread so that pretty much ended the testing. 

So I go back to my original question. How many of you deliberately test your basal rates? 

I understand the logic behind doing it. I understand the value of doing it. (I understand that having a continuous glucose monitor (CGM) would help. I'm anxiously awaiting news that Dexcom has arrived in Canada.) I like to exercise every morning and then compensate for the different exercises by adjusting my breakfast bolus. I like my 40 carb super yummy breakfast shake. Oh, and I don't fancy waking up every hour in the night to test. 

But I will if it's worth the bother. 

Is it worth the bother? 

And, if yes, tell me how you do it, what you eat and any other things that might be helpful to know (like how much variation in blood sugar levels is acceptable and how much warrants a basal change? or how many days in a row would you test before making a change?). 

Oh, and thanks! 

Infinite Loop

On October 12th, I dropped two packages in the mail.

One headed off to Canada Revenue Agency and contained my application for the Disability Tax Credit.

The other headed to my health insurance company and contained an application to have continuous glucose monitor sensors covered.

I have not yet heard about the Disability Tax Credit and don't expect to hear for a few more weeks at least.

I did hear back from my insurance company.

Before I tell you their response, I will explain the process I had to go through.

1. I called them to ask if continuous glucose monitor sensors are covered. They said no.

2. They then explained that, if something is not covered, I could complete an application form and submit a quote from my pharmacy for the cost. They would then decide whether or not to cover it.

3. They would review that application and let me know within 7 business days of their decision.

Make sense?

Here is what happened.

1. I completed the application, obtained a quote from my pharmacist AND wrote a very lovely cover letter to explain the need for CGM sensors.

2. I mailed it in on October 12th.

3. I waited 12 business days (which is way more than 7) and then called them. They said that they had received my application and had no idea why it would take so long to decide. The promised that I would hear back within a few days.

4. Seven days later I received a letter in the mail that stated: we are unable to accept your claim because your contract does not cover this type of appliance / service.

Well no kidding folks.

We all knew after the original phone call a month ago that my contract doesn't cover it. That's why you told me to complete the application to have it covered.

They don't cover it - they tell me to apply to have it covered - they tell me that they won't cover it because they don't cover it.

Insert never-ending loop here...to infinity and beyond!

So of course I will be calling them to find out if there is a better explanation than that and to find out what the next step might be in the appeal process.

The story does not end here and I will certainly keep you posted.

Fingers Crossed

I headed to the post office the other day with two envelopes to mail.

One was headed to Toronto, one to the East Coast.

Both have to do with diabetes.

The first one is my application for the Disability Tax Credit. It contains a cover letter, a five page summary of what I do every day to keep myself alive and healthy and a 9+ page application signed by my diabetes doctor.

I should hear back in 6 to 8 weeks re whether or not I qualify.

The second envelope contains a request to my insurance company to cover the cost of my continuous glucose monitor (CGM) sensors. There is a two-page letter from me explaining how they work and the importance of having them, an application form and an estimate from my pharmacist of the cost.

I called the insurance company last week to see if they covered the sensors and was told that no, they do not. But I could request a review of that decision and should hear back within a week once they receive the information.

Why am I doing this now?

Because of a conversation I had with a new friend from Israel and a new friend from Norway.

Both use the CGM. All the time. Neither couldn't believe that I didn't.

"I have tried it before" I said "they're just so expensive".

"That is not an excuse" was the reply.

Fair enough.

I understand the value of continuous glucose monitoring. It helps identify patterns to better control your blood sugar but, more importantly, it helps keep us safe. Alarms sound when blood sugar drops below a certain number. In the middle of a run or in the middle of the night.

CGMs have saved people's lives - woken them up from a bad low that they didn't feel.

I know. I get it. I agree.

So I'm starting the fight to have them covered by my insurance. So I too can take better care of myself.

All because of my two new international friends.

Thanks boys!