My 670G Tips and Tricks

It’s been about 2.5 months with my 670G pump. I’ve never had such an intense love/hate relationship with a medical device before. When asked if I’d recommend the pump or how I feel about, my honest answer is that I have very mixed feelings about it. And I think the most important takeaway is to have realistic expectations if you decide to get this pump. It is far far from perfect, but it has incredible potential. However, there are many and frequent frustrations, and for me, the pump was not only affecting my sleep (which obviously has implications for all areas of your life), it was also affecting my mood.

One thing I’ve learned over the past 17 years living with a chronic disease is that you have to make it fit into your lifestyle, not the other way around. That doesn’t mean you don’t make changes to the way you live, but it also means that to get through each and every day, you find ways to fit diabetes into the life you want to live. I have a few diabetes mantras, and one of them is “Diabetes does not define you.” My health and safety is always my first priority, but within the confines of this pump, I’ve found some tricks to get me through each day so that the pump is not negatively affecting my mood and sleep.

I’ll stop right here and say that what I’m about to tell you is not the way that the pump was designed and intended to work, so if you choose to try any of the tricks below, you do so at your own risk. I’m not recommending these for everyone, obviously you know what is realistic or not for your own life and circumstances. But this blog is for sharing my personal experiences so that’s what I’m doing.

My 670G Tips and Tricks

1.Be very careful about when you calibrate. Medtronic seems to have a lot of advice about this, don’t calibrate when you’re rising or dropping, don’t calibrate when there’s active insulin, calibrate about 4 times a day. I’ve also found that since I’m a stomach/side sleeper, I try not to calibrate when I first wake up even if it’s asking for one. I give it 30 minutes to an hour for the sensor to even back out. When I get into the cycle that says “Wait to enter BG” sometimes it helps to wait more than the 15 minutes, up to an hour even before entering the next BG.

2. Learn your sensor’s patterns. The sensor is supposed to last 7 days, however this has rarely been my experience. Here’s what my sensor timeline typically looks like:

  • Day 1: sensor is getting used to my body and usually isn’t very accurate for the first 24 hours.
  • Day 2-4: Sensor typically works pretty well, calibrations last close to 12 hours.
  • Day 5: Things start going downhill, either it will say change sensor or will need much more frequent calibrations.
  • Day 6-7: Hah

3. Adapt your manual and auto mode use to your sensor’s patterns. I’ve found that when the sensor is in auto mode, it requires many more calibrations, and that it is much quicker to not accept a calibration and eventually tell you to change a sensor than if it’s in manual mode. This makes sense. Since it’s giving insulin in auto mode, it wants to make sure it’s as safe and accurate as possible. However, if you want your sensor to get the full 7 days (or as close as you can), you can sometimes stretch the use by staying in manual mode for the last couple days. Here’s how it works:

  • Day 1: I keep it in manual mode for most of the day until the sensor is reading pretty close to my finger readings.
  • Day 2-4: Auto mode
  • Day 5: This is often where I get to the point that it tells me to change sensors. So now instead of cursing and getting mad, I disconnect the sensor from my body and charge it while turning off the sensor on my pump. Then I reconnect the sensor and “trick” the pump, telling it that it’s a new sensor. I then go through the warm-up period. For me, this works about half the time. If the sensor has gotten bent, then this trick won’t work, you’ll still end up changing it.
  • Day 6-7: Manual mode

4. If you feel comfortable, alert silences can be a great thing. I always calibrate my sensor right before bed, hoping it will last the 12 hours. However, if you’re close to day 5 and beyond, the sensor will often ask for a calibration 6 hours later, which for me is around 4 or 5 am. I was waking so frequently that my body started automatically waking up at 5 am every morning, and I would have trouble falling back asleep. So now, I make a judgment call each night. If I feel pretty sure that my blood sugar isn’t fluctuating too much, I sometimes choose to silence all alerts for the night. This way it won’t wake me up if it needs a calibration. I did find that it does still vibrate for low blood sugars. The pros: an undisturbed night of sleep. The cons: if it does need a calibration during the night, you won’t have any readings and if you’re in auto mode, it probably will eventually kick you out. So ultimately this comes down to what you’re personally comfortable with. I don’t silence the alerts every night, more so for the nights I just really want an undisturbed night. And I’ve always been able to feel my lows during the night so I don’t rely as heavily on the pump alerts. Then if I wake up at 4 or 5 in the morning, I’ll often calibrate anyway. But at least then it’s my body waking me up, and not my pump.

Everyone’s needs and experiences are different. My “tricks” might not work for you or fit your lifestyle or may not be how you want to be using the pump. But maybe they do help. Either way, I’m all about sharing and learning from one another.

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Sensors and Censors

F***!!!!

Anger is an interesting emotion. It heightens your senses, it gives you a physical reaction. It’s powerful. It can spur you to take action- for better or worse.

I’ve been feeling a lot of anger lately. But this anger feels different. I’ve been struggling to figure out what I can do with this anger, how I can channel it into something productive. Something that can solve the problem so there are less angry situations, something that will make me feel at ease. But what makes this anger different is that I feel completely trapped in the situation. It’s a situation with limited options to make it better, options that while might temper the anger, will have other negative consequences, potentially even to my health. I weigh these pros and cons and I feel a sense of helplessness.

With my new pump, I’ve been using new sensors. These sensors are what the pump relies on for blood sugar numbers to make decisions to give more or less insulin. They are what the defining feature of this pump is dependent on. These sensors are supposed to last 7 full days. This was already a disappointment as the sensors I was using before often lasted 10-14 days. In reality though, these sensors are lasting around 5 days on average before a new one needs to be inserted. And after day 4, for the rare ones that do last longer, they are becoming less accurate and need more calibrations. They end up waking me in the middle of the night when the calibration only lasts 6 hours instead of 12.

changesensorYesterday, after wearing the sensor for 3 days, I got a message that the sensor was updating and then a message that said, “Change sensor. Sensor not working properly insert new sensor.” In that moment I was furious. I screamed obscenities in my head at my sensor and texted my boyfriend the picture of that screen with 10 emojis of the middle finger and angry faces.

So what’s the big deal changing a few days early?

  1. It’s disruptive. It means the pump isn’t working to its full potential. It means until I change the sensor, I don’t have information about my blood sugar without poking my finger. So now I’m having to poke my finger more, I’m missing the data I rely on, and I’ll have to wait up to 2 hours for it to start again.
  2. It’s a pain, literally. Sometimes the insertion hurts, and I don’t know about you, but I don’t like doing things that hurt more often than necessary.
  3. It’s expensive. The faster you run through them, the sooner you have to order more. And they are not cheap.
  4. It wastes time. Medtronic will replace many of the sensors, especially ones that stop working after only a few days. But this could mean being on the phone for anywhere between 20-45 minutes with the person. Then having to wait while they ship a new sensor out.
  5. It’s supposed to work! Forgive me for thinking that the expensive medical device that I use is supposed to be reliable and consistent and accurate and cause less hassles, not more.

I understand that this particular pump is new, and by being one of the earlier people to get it, that there may still be kinks that they’re working out. But I also still feel like my anger is valid. So when I see that screen that tells me to change my sensor days before I should be, I get angry. But I also feel stuck because I made the decision to switch to this pump. And this is the reality. Can I get a different pump? Maybe? Might be a hard sell to my insurance who only covers new pumps every 3-5 years. Do I really want a different pump? I don’t know. When it’s working, the pump is great and truly is cutting edge.

So I’m stuck with a strong emotion that I don’t know how to productively channel. I’m pretty sure yelling F*** every time it happens doesn’t count. So what am I doing, what can I do about it? I’m speaking up. I’m telling my doctors what I’m experiencing, I’m blogging and telling you about it. I’m telling my Medtronic trainer. I’m telling anyone who asks me about the pump and is considering switching themselves. If improvements are going to be made, the company needs to know what’s not working. If people are going to switch to this pump (which I still encourage for all the benefits it does bring), I think they should be informed about the downsides too and have realistic expectations.

And until improvements are made, I’ll deal with my anger. And be thankful that I work from home when that involuntary “F***!” sneaks out after another sensor fails.

An update on the 670G pump

It’s been 3 weeks since I started on my new Medtronic 670G insulin pump, 21 days since that life changing day I wrote about. So you’re probably wondering if it’s as great as it seemed to be after those first 2 hours. Honestly, no, it hasn’t been as smooth and hassle free as I had hoped. But after 3 weeks, I can definitely say it’s made an improvement to my life and my blood sugars and I’m so glad I made the switch.

Let’s start at the beginning. About 3 hours after posting how great the pump is, it kicked me out of the auto mode and I got stuck in an endless loop of it asking me for a blood sugar to calibrate, calibrating, asking for another blood sugar, processing, and then saying to wait. This went on for hours. Finally I called the medtronic helpline and spent an hour on the phone with a support person. After the hour, he still couldn’t fix it and I ended up having to take out the sensor which was working fine. It was a frustrating start.

After putting in a new sensor, things seemed to be going better for awhile. I was able to get back in the auto mode feature. My blood sugars have had way less drastic highs and lows, although I still find myself in the 200/250 range and the auto basal doesn’t seem to do much to bring it down. I’ve also had fewer lows especially those that are a result of correcting for the high spikes.

The alarms are a bit annoying, I find that even if I calibrate before bed, it still might need a calibration in the middle of the night, and I get awoken by the buzzing. I find that most often when I do get kicked out of auto mode, it happens during the night. I’ve also gotten stuck in that same loop of repeatedly asking for a blood sugar and not getting back into auto mode for a few hours a few more times. But luckily I haven’t had to take out any other sensors.

I had my 3 month endo appointment yesterday, and even after only having the new pump for 3 weeks, my A1c dropped half a point, so obviously it’s helping. I’m optimistic that the number will be even lower at my next appointment.

Is the pump perfect? No. There are a number of annoying features and issues that happen. But that comes with being an early adopter of a new technology. Am I glad I went through all the waiting and headache to switch? Hell yea! Even with its issues, I can see the positive effect this pump is having. And some of it is still user error. I’m sure my numbers would be even better if I remembered 100% of the time to prebolus my meals and improve other habits.

As someone reminded me, it’s not a magic pill (or pump) that’s going to suddenly make every blood sugar perfect. It’s still a piece of technology that has made advancements, but still requires effort on my end too. With that in mind, I’m eager to see what happens in the next 3 months.

 

 

A life changing day

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.

 

 

The Fighting Kale

There are a lot of words that I could use to describe myself, but gardener is not one of them. In fact, I often joke that I have a black thumb, killing even the hardiest of plants. My boyfriend on the other hand, loves to garden. When I managed to nearly kill a succulent, he nursed it back to health. When he talks about his plants that he grew in containers on his balcony and the vegetables that he harvested, his face lights up. You can tell it’s something that he’s passionate about. So when he suggested that I try to grow some vegetables on my apartment balcony with his guidance, I figured I’d give it a try.

DDDC4FF2-A5D5-439B-82DC-845CF497CFD3We planted 2 kale plants, one beet plant and some chives. I’ll admit, it was pretty amazing to see the transformation of the plants in just a few weeks time. My garden consultant would examine the plants and tell me when to water and how much, helped spray the plants with organic pesticides and just generally kept an eye on how things were going.

It became a ritual each morning to check on the kale plants and report back the progress. Everything seemed to going well until random holes started to appear on the leaves. At first I couldn’t tell what was causing it, but then we found the culprits: baby cabbage worms.

kale3

Get off, worms!

My boyfriend picked them off and we sprayed the leaves again. I thought that was the end of it. We went out of town for a long weekend and returned to devastation. The poor kale plant was almost completely devoured by the now rather large and plump worms.

IMG_6009

At least someone’s enjoying them

It was a sad sight. The worms had won. I’ll admit that I pretty much gave up on my kale plants. It was a good first attempt at gardening, my black thumb prevailing in the end. My boyfriend cut off the mostly eaten leaves, leaving the middle stem, hoping for the best.

And guess what?! Those darn kale plants are fighters! They’re growing giant, strong leaves, with more leaves constantly starting. I look at the plant and I can’t believekale5 it’s the same one that I had practically written-off as a failure. I’m sorry I doubted you, kale. You survived the worm invasion and came out even bigger and stronger than before.

So why am I telling you about my gardening adventures on my blog about diabetes? I’ve been having a really difficult and frustrating time with my pump and CGM the past 3-4 months, which has resulted in poor blood sugars, bad moods, and a lot of frustration and even tears. I haven’t blogged in awhile because I didn’t want my blog to turn into a place of negativity and complaining.

While sitting outside working today, admiring the recovery of my kale plants, I realized that I am in the midst of my own worm invasion. (Metaphorically. Don’t worry, I don’t have worms). Things are hard right now. I feel my mental and emotional resources depleting. It’s sometimes hard to stay optimistic. But I, like my kale plants, am a fighter. And I too hope that in time, I’ll be even stronger and healthier than I am now. I wrongly doubted my kale plants, I won’t make the same mistake with myself.

kale4

 

 

Hurry up and wait

My new medtronic 670G insulin pump is sitting in a box in my living room. It’s finally here.

When I first decided to upgrade to the new pump, it was around January and they told me that I should have it in spring. Well come May, I got a phone call that the process would start, but still no pump. They told me early summer. So I waited. In June I got another call, 3-5 weeks they said. So I waited some more. And finally, mid July, it’s in my possession. But now I have to wait to be trained on it before I can use it, so there is sits in my living room, still waiting to be used.

I should be elated, but instead, I feel like the Grinch on Christmas morning. I don’t know when I became so pessimistic, so skeptical. It’s partly my fault. I got caught up in the hype, after all it’s the “world’s first hybrid closed-loop system.” There were articles calling it the “first artificial pancreas” a “game-changer device.” It must be something great!

But I’ve been so utterly disappointed and frustrated by the 630G that my expectations are now very low for this new pump. And the mixed reviews that are starting to trickle in from people using the 670G doesn’t instill a ton of confidence. But don’t be mistaken, I am still excited and feel very fortunate to be able to use this pump. I just want to be honest with how I’m feeling. And with low expectations, I sincerely hope that my new pump far surpasses them. I hope I’m proven wrong and can come back and write how much I enjoy the new pump and the positive difference it’s making. I really really do.

So back to the waiting. On the plus side, gives me a bit more time to work on my pre-bolusing.

 

Being a cyborg

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.

 

Explanations

I’ve learned over the years that I’m someone that craves explanations. I want things to make sense, I want to know why something may have happened. I need logic.
Granted, I don’t always need to know exactly why something happened, sometimes we just don’t know, but I find myself still wanting to make an educated guess. And when there is a disconnect between what happens and a proposed explanation, I get frustrated. “That’s impossible! There’s no way that what you just said could have caused that.” Those close to me are all too familiar with my need for logical conclusions, and my irritated response when I’m not satisfied with the answer.
But I know we don’t always get answers. Why do bad things happen to good people? Life is random, mysterious, and unpredictable at times, it’s part of what makes it both devastating and exhilarating. In many cases I’m perfectly content with the explanation that sometimes things happen that there are no logical explanations for, it’s the universe at work.

My diabetes falls somewhere in the middle.

Too many times I’ve found myself frustrated with a high or low blood sugar, not understanding why it happened when it seemed that I did everything “right” to avoid it. I rack my brain trying to come up with a logical explanation, but sometimes there are just too many variables to consider. Was I really that far off in my carb counting? Is this a delayed effect from the exercise I did earlier? Is something wrong with the insulin? Is there a bend in the tubing? Is the insulin not being absorbed at the site? Am I getting sick? Am I stressed? So much to consider, I can’t always draw a one-to-one connection for a high or low.

Last week I was shocked to see a blood sugar that was over 500. A rare event, my first thought was why?? Well really it was “Oh f*ck” but then why did this happen?!? I ran through the list in my head as I tested my ketones, gave myself a shot, and changed my infusion set.

You don’t always get answers for everything in life. I’ve learned to accept it and move on with the information that is available.

But sometimes, when you’re lucky, you get exactly the explanation you need.

bent infusion set cannula blocking insulin from being delivered

2015 Diabetes Blog Week Day 4- Changes

Diabetes Blog Week

When I think about diabetes and what I’d like to see changed, one word comes to mind. Well maybe 2, a cure would be a nice change. But the word I’d like to focus on is integration.

Integration. I could yell it from the rooftops. Integration would make diabetes so much easier to manage. It would make communication so much more effective. It would make our lives in general a little less burdensome. 


What exactly am I talking about?

I want diabetes devices talking to other diabetes devices. I want my pump, my meter, and my CGM to all communicate constantly. And while I know this is unrealistic, I wish that this communication could happen across companies so that my dexcom CGM could talk to my Medtronic pump or a Bayer meter could talk to an animas pump. I want numbers and data flowing freely from one to the other, whether it’s then used in a calculation, helping to inform a decision, or just being stored for later retrieval.

I want diabetes devices talking to non diabetes devices. I want my CGM numbers and my pump talking with my phone, presenting my data (carbs, boluses, blood sugars) in an easy to read and accessible manner in an app. I want their data showing up on a graph on my computer or tablet. I want other apps that I’m using to integrate in a platform with my diabetes data, whether it’s food tracking that I do or exercise tracking. How great would it be for one app that would have my carb and bolus information from my pump, graphed against my blood sugars that are collecting from my meter and CGM, informed by my Fitbit tracker active minutes and steps, and integrated with the food that I tracked during the day in My Fitness Pal?! Think about how much easier it would be to see a trends and potential causes for highs and lows. Based on the food you ate here, it looks like you gave too much insulin and that’s why you dropped low here.

I want ALL of these devices talking to my doctor. I want to be able to walk into my endocrinologist’s office or even my primary care physician, or eye doctor, or really any doctor’s office and have all of this information available to them. I want the information from all of my devices to be consolidated into a format that is integrated right into my medical record. Then when I go to the endo, they aren’t making suggestions based off of just my CGM, they are looking at the complete picture with little burden to me since all of this uploading, syncing, and integration happens automatically. 


I’m hopeful that these changes are coming soon, that this is the future of diabetes self-care. Integration will be a requirement, not just a nice feature. 


This post is part of the 2015 Diabetes Blog Week. Today’s topic: 
Today let’s talk about changes, in one of two ways.  Either tell us what you’d most like to see change about diabetes, in any way.  This can be management tools, devices, medications, people’s perceptions, your own feelings – anything at all that you feel could use changing.  OR reflect back on some changes you or your loved one has seen or been through since being diagnosed with diabetes.  Were they expected or did they surprise you? You can read more posts on this topic here

I’m a cord tucker

Ninety-five percent of the pants I own have pockets. When I wear a skirt, my pump is clipped somewhere that is not visible. My pump stays in my pocket, secure and hidden away.

In many ways, diabetes is an invisible disease, or visible only when you want it to be. I don’t think you could look at me and be like, “Oh yea, she has type 1 diabetes.” You might see me checking my blood glucose number, or take my pump out of my pocket to bolus for my lunch, maybe you see that I’m looking a little off from a low, but otherwise I don’t think I look any different than you do.

I’m a cord tucker.

But do you have a cord constantly hanging below the hem of your shirt? A cord through which life sustaining insulin travels. I have a cord. And in some ways that cord is symbolic of the difference between me and you. That cord is a visual reminder of a disease that I live with and manage every single day. But other times that cord is a sign of solidarity. Like when in a random bakery in Detroit, I saw your cord and knew right away that we had something powerful in common. That cord ties us together.

I’m a cord tucker.

Sometimes it’s a safety issue. I don’t want the cord to get wrapped around a knob or something and yank my infusion set out. So I tuck it into my pants so that it doesn’t hang freely. But sometimes it’s not about safety. It’s about not having to talk about my diabetes or answer questions when I don’t feel like it. It’s about remaining invisible when I want to be.

Yesterday, I hung freely.

I let my cord show. Yesterday it didn’t matter to me. I didn’t care who saw it. But you stopped me in the office kitchen, “I don’t mean to touch you, but there’s something hanging off your shirt,” you said as you reached towards my cord, ready to break it off like a loose, dangling thread. I didn’t care if it showed or not. But you did when you told me that my “stuff was all over the place,” gesturing to my cord hanging on my chair. You weren’t being mean, or judgy. You were trying to be helpful and maybe even concerned. You weren’t used to seeing a cord, and now you did. But do you really care if my cord is showing? Do I care? Maybe. Maybe not.

Today, I’m a cord tucker.