Category Archives: devices

A life changing day

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Today is a life changing day.

No, seriously.

Today, I woke up early, drove 45 minutes to my second training for my new Medtronic 670 G insulin pump, and they turned on the auto basal feature on my pump. What does that mean? It means that this first pump of its kind now has the ability to see what my blood sugar is and every 5 minutes, all on its own, give micro amounts of insulin to make sure my blood sugar stays as close to 120 as possible. It means that if my blood sugar is going up, it will give more insulin, and if its dropping low, it will give less. ALL ON ITS OWN!!! Yes, I still give insulin when I eat or give corrections when necessary, but it is working to manage my blood sugar in the time in between so that I hopefully don’t need to be giving corrections at all.

I’ve been open about my struggles to keep my blood sugars in range, I experience a lot of roller coaster ups and downs, and while my A1c has fluctuated over the years, I’ve never been able to get it to 6.0, a goal that I work every day to achieve. I’ve experienced frustrations, burnout, sadness as well as pride and celebrations over the years, but this new pump feature has the potential to be life changing for someone like me and many others with T1D.

pump2.jpgIt has literally only been about 2 hours since I turned this feature on and I’m sitting looking at one of the straightest, steadiest, in-range blood sugar graphs and I can’t help but get emotional. I have tears falling down my cheek as I type this. I don’t know that I can communicate everything that I’m feeling right now. For some of you, maybe you can relate, and for others, I hope I can come close.

Diabetes is all consuming. You have to be thinking about it all day, every day. You can’t take a break, you can’t say, “I don’t want to deal with you right now” without facing consequences to your health. Diabetes takes so much time and energy, and some days can be so physically and mentally exhausting. It’s exhausting when your blood sugar is running high and you’re not exactly sure why, it’s exhausting when you’re exercising or out with friends and it drops low and you have to stop what you’re doing and treat it and wait to feel better. It’s exhausting just not feeling your best or being able to give your best because you feel low, or high, or just off. It’s exhausting feeling like you do so much, but don’t have the numbers to show for it.

pump1.jpgJust the idea that this pump is literally asking me to give up a lot of control, trust the sensor, and let the pump do some of the work is simultaneously terrifying and liberating. It takes away just a little of the burden of living with diabetes, but even that little bit counts for so much! And I am so grateful and excited that a pump with a feature like this finally, finally exists. The fact that I potentially won’t have as many roller coaster highs and lows is such an incredible thought that is almost too good to be true.

I’ll let you know if I feel the same way 2 weeks into wearing this pump as I do 2 hours in, but for now, I am just so thankful to finally have a piece of technology that can truly help me in a way that I haven’t experienced before. And while it’s not a cure, it’s definitely a step in the right direction.

 

 

You put the “um” in “numbers”

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“What do the numbers say?”

Numbers are often seen as this objective piece of data. And because they are objective, they cannot lie, right? We might not always like what they tell us, and they don’t always tell the complete story, but they’re often hard to argue with. How’s my blog doing? Well let me check the analytics and number of viewers. How’s my health doing? Well let me check my blood work: my blood pressure, my cholesterol numbers, my A1c. Success criteria is often operationalized in numbers. Who won the race? Let’s check the times. Who won the game? Let’s check the score.

You learn to trust the numbers. And while you can interpret the numbers differently, put them into context, explain the variance or trends with outside information and external variables, the numbers are what they are.

You start to crave the numbers. If some numbers are good, more must be better. I recently switched to a smart scale. I wasn’t just content with knowing my weight, I wanted to know my body fat percentage and my muscle mass percentage too. More numbers could help elucidate what’s really going on in my body and alleviate any uncertainty. If I’m working out more, but I’m gaining weight, I would feel much better knowing the weight was coming from more muscle mass and not body fat.

You rely on the numbers. They show your progress. They show your weaknesses and your strengths. The numbers are your guideposts.

So imagine how you’d feel if those numbers fail you. When all of the sudden, they can’t be trusted. And instead of helping you, they lead you astray.

Lost? Frustrated? Angry? Disappointed?

That’s how I felt as I returned home from my 3 month endo appointment this week. In the past 3 months I’ve had one major change, I switched insulin pumps and continuous glucose monitors. I was having so many issues with the sensor leading up to the appointment. It would suddenly stop working after only 1 to 2 days, it was inaccurate compared to my finger tests, the trending arrows were completely misleading. I told my doctor these problems, but I was still optimistic. After all, I had started eating healthier, been more consistent with my metformin to help with blood sugar spikes, I didn’t feel like my A1c should have been much different from 3 months earlier. But I was wrong. Those inaccurate numbers had contributed to my A1c going up .6 of a point. This may not seem like much, but when you are trying to get below a certain number and are at the lower end, to suddenly be back at the higher end is very discouraging.

numbersAll day I alternated between being livid and just feeling sad. I felt let down by the numbers I rely on every minute of the day to be healthy. By the end of the day, I made the decision to switch back to my old, reliable sensor. Enough is enough. My health shouldn’t be made worse by the devices that are meant to improve it.

Numbers are complicated. So is having diabetes. And that means being critical of the numbers, always. Because what is meant to be helping you could actually be making things worse if you aren’t careful.

 

 

 

Meet the Dario Smart Meter

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About a month ago, the company Dario contacted me and asked if I would be willing to test their new diabetes management system and meter. Always interested in trying the latest and greatest, I happily agreed. Dario supplied me with the meter and a limited supply of test strips and I downloaded the app on my phone. So here is my honest review of the meter from my experiences over the past couples weeks.

The Packaging

imageLet’s just say, the meter makes a damn good first impression. I’m someone who appreciates the artistry of a well packaged device. I love opening Apple products for that very reason. All my past meters have just come in a normal box, nothing special. The Dario meter was not like that at all. Every piece had a place, the packaging was slick and sophisticated. It was a pleasure to unpack this medical device, and that says something.

The instructions and reading material was conveniently hidden within the box while the lancets were cleverly stored in a neat compartment next to the meter.

The All-in-One Device

There are 2 things that make this meters and management system so unique. The first is that it turns your smartphone into the meter (more to come on that later). And the second, is that the lancet and test strip holder are combined into one, well designed and easy to use device.

Holding the device, it doesn’t look anything like past glucose meters I’ve used before. Without knowing what it is, I never would have guessed what it was used for, which is great if you like to keep things discreet.

The Lancet

The needle is housed on one end of the device. To access it, you just snap off the top orange piece. You can set the depth of the needle, and then you follow the arrow and pull down on the black piece to load the needle before pressing the orange button to release it. Super simple.

Test Strips

They’re stored on the other end! How awesome is that?! No need to carry around multiple pieces. The cartridge of 25 test strips just snaps into place. You just remove the white piece at the end. The box of test strips came with two 25 test strip cartridges.

The Meter Attachment

The Dario system turns your smart phone into your meter by plugging in a small attachment into the headphone jack. The attachment is also stored in the all-in-one device.

The Meter

The packaging on the box clearly explains how to download and set up the app on your phone, walking you through the set-up. To test your blood sugar, you plug in the attachment and open the app. If the attachment is in correctly, it will prompt you to insert a new strip and then place a drop of blood on the test strip. The meter counts down by filling in a circle before displaying the glucose number. It uses a color coding system to visually show if it’s within range, borderline, or high. It then immediately takes you to a screen that allows you to indicate if its pre-meal, post-meal or a bedtime reading and then insert additional information related to carbs, insulin, physical activity, and even tags.

The App- Tracking and Analytics

Overall, I’m impressed with this app and how intuitive and easy to use it is. I think it does a really good job of logging important information and then displaying it in a meaningful way to the user. You are able to set up a personal profile which includes your blood glucose thresholds, hyper/hypo warnings, and then the type of basal/bolus medication you use.You can sync fitness apps, track food, and set reminders in the app.

Logbook and charts

imageThe app automatically stores every reading in the logbook and you can decide if you want to view it more as a list, a timeline or a chart. The chart will graph up to the last 14 days. You can also easily share your logbook either as a PDF or CSV with your phone contacts or by entering an email address.

The statistics tab gives you a great summary for the day, or the last 7, 30 or 90 days. It will tell you how many readings you had, the lowest and highest and then breaks it down by how many were in range, below or above range and then how many hypos/hypers you had based on your settings. If you click the summary box, it will show you all the readings that fell into that category. It also shows on the website that the app estimates your A1c.

 

Things I like and Areas for Improvement

What I love:

  • I love how everything fits together into one device. Instead of carrying around my pouch with all the separate pieces (meter, test strips, lancing device, etc), all I really need is the one device and my phone
  • It’s great at logging everything and makes it super convenient to share
  • I don’t have to worry about charging my meter, as long as my phone has battery, the meter will work

Some drawbacks/areas for improvement:

  • It’s a slightly slower process. Maybe I’m just used to my old meter, but I find that the whole process takes a little longer to test. Since it’s an app on my phone, I need to unlock my phone, open the app (sometimes it takes a second to load), insert the attachment and then test. Don’t get me wrong, it’s still a relatively fast process, but I found that when I was in a hurry, I resorted back to my old meter
  • It doesn’t sync with any other diabetes devices. This might be the biggest drawback. My other meter at least would send the reading to my pump. This meter doesn’t. So if I’m correcting or bolusing, I have to manually enter my bg number in my pump.
  • My summary feels misleading. I have a CGM that I use in addition to my meter.  Most often it’s when my CGM says that I’m high that I test to get a more accurate number to correct and give insulin. For that reason, high blood sugars are over-represented in my logbook on the app and isn’t really capturing the whole story. If the app was able to integrate with my CGM, it would give a much more accurate picture of my blood sugar history.
  • Greater integration. This is not only with diabetes devices, but also other apps. It’s great that you can link a fitness app like runkeeper, hopefully the list of apps or wearable devices that it links with will continue to grow and include some food tacking apps as well, like MyFitnessPal. It would be great if the app could be used as a one stop shop for diabetes health more generally, including fitness and healthy eating. Also, it would make entering data related to fitness easier. Currently it asks you to enter physical activity as calories burned whereas entering the amount of time would be easier.

 

Being a cyborg

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Maybe I’ve been watching too many comic book and sci-fi movies/shows lately, but I’ve come to the realization that technically, I’m kind of a cyborg thanks to my insulin pump.

Well first, I had to look up the actual definition:

Cyborg– noun
1.
a person whose physiological functioning is aided by or dependent upon a mechanical or electronic device.

My physiological functioning is dependent on my insulin pump essentially acting as my pancreas. And while it’s technically not built into my body (maybe it will be in the future), it’s still attached at all (well, most) times. But upon reading other definitions, most cyborgs’s mechanical or electronic device allows their physical abilities to extended beyond normal human limitations. While my insulin pump makes my diabetes much easier to manage, it’s still not the same as an actual working pancreas and so it probably wouldn’t qualify in that sense.

But that’s not the aspect of the pump that I want to focus on today. Instead, let’s talk about one small feature of it, the light.

IMG_0371My insulin pump has a button that turns on the screen’s back light. This makes it easier to give insulin in the dark. But its uses extend beyond merely giving insulin. I essentially have a built in flashlight at all times.

When I get up in the middle of the night to use the bathroom, I turn on the light and use it to guide me through the dark. Unlike the jarring light from a phone, the brightness doesn’t rouse me from my slumbered state.

My reliance on my light is most apparent when the battery in my pump needs to be replaced and the function stops working. I stumble through the darkness to the bathroom, cursing myself for not replacing the battery when I first noticed it was low. No matter where I am, a dark movie theater, my bedroom, or even a cave, this light is always available (and connected) to me, allowing me to illuminate the darkness. It extends my abilities beyond normal human limitations.

In many ways, my type 1 diabetes has essentially given me both physically and metaphorically, a light in the darkness.

 

Mission: Secure Lost Meters

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I sat in the car with that satiated, content feeling you get after a particularly satisfying meal. However, I was feeling extra thirsty, which was odd since the beer and multiple glasses of water should have been sufficient to quench my thirst. Tuning into my body, I realized it was the symptoms of a high blood sugar that I was experiencing.

I started digging around in my purse, looking for my CGM. I felt around in the endless abyss that is my work bag, but nothing was feeling familiar. My searching became more frantic. “Where is it?!” I thought. “It should be here!” Okay, well if I couldn’t find my CGM, I would at least test my finger so I could tell how high I was.

My hand went back into my bag, but again came up empty. Gigi AND my glucose monitor, both gone?! How could this be?? I started to panic slightly. I felt lost. Rarely am I without both my meters, no way to tell exactly how high I am and how much insulin to give. I could guess, but if I was way off, the consequences could be serious.

“I don’t know where my meters are, either of them. They should be here! I need them. What if I lost them?” Eyes wide, I dumped everything out of my purse, searching the surrounding area. But the search was futile.

“Relax,” said the voice of reason sitting next to me. “I’m sure they’re not lost. They probably fell out in your car.”

Yes. Yes, that would make sense. They’re probably in my car. But I don’t remember taking them out of my bag. But maybe they fell out without me noticing. I’m sure they’re there. Where else could they be?

“Yeah, you’re probably right.”

The 10 minute drive back to my car seemed to drag on forever. I tried to enjoy the music and the company, but my mind was focusing on only one thought: finding my meters.

We arrived back at my car. I wanted to run and fling the door open, but I kept my composure. Of course they’d be there, what was the rush?

I opened the passenger door and picked up the coat on the seat. They weren’t there, either of them. I looked on the floor, in the back seat, between the seats, nothing. Defeated, my mind pictured Gigi abandoned on the side of the road. Who would find her? How would she be returned to me? Was she gone forever??

“I’m going to go check my office. Maybe I left them there.”

It wouldn’t have been the first time that I would have left Gigi under a pile of papers, out of sight and out of mind. We loaded into my car and drove across town on a mission to return my meters home safely. We pulled up to my darkened office, it was 10:30 at night and the only light was from the cleaning people finishing up for the evening. I walked inside, making my way through the darkness to my office. I lifted the papers scattered across my desk. Gigi! My beautiful CGM! I was so relieved. But where was my other glucose meter? I looked in the drawers, on the floor, and all around. It wasn’t anywhere.

I returned to the car, perplexed. It’s happened before that I’ve forgotten my glucose meter at home on my nightstand, where it sits over night. And it’s happened before when I’ve left my CGM at the office. But both in the same day?? I suppose it was possible, I needed to believe it was.

At this point I was feeling mad. I was mad at myself for being so forgetful. I was mad that my diabetes was being so disruptive, and in this case, I was to blame. Rather than being able to relax and enjoy my evening, I instead spent it in an anxious, sour mood driving across town. I was feeling bad for the guy I was with who insisted on accompanying me and for inconveniencing him as well.

“I’m sorry, I know this isn’t how we imagined spending the rest of the evening. Thank you for coming with me.”

“You don’t need to apologize. We got to go on an adventure together. I know you’ll find the other meter too.”

I drove home, ran up the stairs, and went straight to my bedroom. Sitting on my nightstand where I left it was my other meter. Relieved, I alerted my mission comrade that it had been secured and that all was well (except for my blood sugar).

Looking back, I’m still upset that I managed to leave both meters separately in different places, but that’s not what I’m going to choose to focus on. Instead, it was the attitude of the person that I was with that has stuck with me.

There are lots of times when my diabetes has ruined or altered plans that I had. Maybe it was a low that made me stop what I was doing, maybe it was forgetting supplies and having to drive back and get them, maybe it was running around trying to find a battery because my pump had died, or maybe it was just having to make different arrangements to accommodate my schedule or needs. It can be annoying, frustrating, and upsetting. But as I was reminded, you can’t let it ruin your plans, or your mood. Every cloud has a silver lining, a forgotten meter is a chance to go on an impromptu adventure. I’m just glad this mission ends with a smile.