The Case of the Missing CGM

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Gigi was no where to be found!

This is not good. Not good at all. Now I have to be honest, I’m not always the best at looking for lost items. My mom used to tell me not to bother her to help until I had really looked for something three times first. But this just wasn’t one of those times. I was sure of it.
I was getting ready to retire for the night and realized that I had no idea where my CGM was. My first thought was to check my bags. I had a kickball game that night so I checked my kickball bag, I checked my purse, and I checked the bag that held my clothes from changing after work. I checked all my pockets, in my pants and jackets. I couldn’t find it in any of them. I walked over to the couch thinking it may have fallen into the cracks. I lifted all the cushions, but no luck. 
I checked all the counters, I checked the garbage, I went outside and checked my car. It was lost. 
What if it fell out of my bag at kickball?! I don’t really remember taking it out of my bag, but what if it’s lying on the grass somewhere? Or maybe it fell out when I was walking to the car! Would someone pick it up? What would they do with it? 
So far I’ve been really good at keeping track at my medical devices. Granted the pump is connected to me so it’s a little difficult to lose, but I’ve managed to hold on to all my meters and supplies over the years. This just wasn’t like me.
I carried all my bags to my room, checking them all a second time. It felt weird to go to sleep without Gigi on my nightstand, but I had a plan. Most nights I hear Gigi vibrating from either having a high or low blood sugar. I would just wait until I heard it vibrate and then figure out where the noise was coming from. And if I didn’t hear it, then I would know it’s not in my room. 
The next morning, I awoke refreshed from an undisturbed night of sleep. I never heard Gigi go off. It couldn’t possibly be in my room. Now I was really starting to get worried. Where could it be?! There are only certain places where I keep my CGM, and it wasn’t in any of those places. I did one more sweep of my house. I was getting ready to walk out the door for work, without Gigi. I stopped to write a note for my family to see, “Can’t find my CGM, help!” 
I would just have to go through the day without Gigi and look again later. I reached my hand into the small outside pocket where I keep my keys, but it wasn’t my keys I grabbed. Gigi!! It must have fallen into that pocket by mistake. I looked through this bag 3 times, how did I miss it?! Relieved and a little embarrassed by my inept searching skills (*sigh* you were right, mom), I crumbled up the note. 
So it was in my bag the whole time. But why didn’t I hear it vibrate that night?
This is why:
Of course I would have a night of great blood sugars the one time I actually wanted it to vibrate! I’m just glad it wasn’t lost! Also, maybe I need to work on my searching skills…

A Melody of Hope

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I know my beeps. I know my beeps similar to the way a parent can recognize the cry of their baby. I know the sounds that my insulin pump and meters make. I don’t get them confused with other alarms, dings, and noises of everyday life. And since I’m usually not surrounded by other pump wearing diabetics, I know that the beeps are for me. That is until I go to a diabetes event. What a strange phenomenon it is to be surrounded by dozens of other diabetics. My beeps become lost in a sea of similar noises, mixing with the sounds of countless other pumps and meters. My unique identifier becomes a unifying force, a sound signifying a shared experience.

My contribution to this year’s mosaic mural

The past two weekends I’ve had the pleasure of attending 2 different JDRF walks, one in Chicago and one in Ann Arbor/Dexter. In Chicago, I was volunteering with an amazing organization called Project S.N.A.P, collecting artworks drawn at the walk by T1Ds, their families, and their friends to become part of a giant mosaic mural. You can read more about my experiences with Project S.N.A.P in this post, or on their website. The second walk I attended as a representative of the Young Leaders Committee of my local JDRF chapter. It was the second JDRF walk that I’ve ever attended as a walker.

I attended my local diabetes walk with my mom. The walk was in a beautiful Metropark, the path winding through trees with changing colored leaves. Although it was raining, it was still a beautiful and enjoyable walk. At one point my mom turned to me and asked if I was sad/upset that we didn’t really do these walks when I was growing up. I wasn’t mad. Mostly because I knew that my family always supported me. The walk that day was a perfect example. Knowing that I wanted to go to the event, my mom skipped her normal Sunday plans to wake up early and drive 45 minutes to walk in the rain with me.

But even though I am not upset, I know that I did miss out on some amazing experiences. When I looked around at the walks, I saw teams sometimes with 10-30 people all there for one special type 1 diabetic. They were there showing their support by physically coming together, by putting on their team t-shirt with their creative names and bright colors, and spending the morning dedicated to that one child with diabetes. I can only imagine how special that child must feel. Yes, they were being singled out because of their diabetes, but in a positive way. For at least one day each year, that child isn’t alone in their experiences. They aren’t the only child with diabetes. They are able to come together and see other children just like them, to meet and talk with them.

My parents had their own reasons for not pushing to go each year, but I know that if I had expressed an interest to attend these walks when I was younger, that we would have gone. Perhaps I didn’t know at the time what I was missing out on. I was content with the support from my friends and family and with the few other diabetics that I knew.  But these past two weekends while I stood in a sea of other diabetics, I heard those beeps, my beeps. And while it was confusing and odd to hear them, each beep seemed to say “You. are. not. alone. beep. We. are. in. this. together. beep.”

It was the melody of hope, of support, and of all the efforts to find a cure.

Strange Familiarity

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Over 1000 people filled the performance center, all of us sitting with our eyes focused on the dancers on the stage. No one was talking, no one was on their phone, everyone was staring straight ahead.

I had gone with my parents to see a contemporary dance performance by a professional dance company that was touring. It was the middle of the second dance, about an hour into the show. I started to look around at the audience instead of the dancers moving across the stage. What are all of these people thinking in this very moment? Here we all are, physically in the same space, listening to the same music, watching the same dancers, yet each of our experiences could be completely different. Unlike a play or a movie, there isn’t a real plot. While the dances are open to interpretation and inspired by different things, there isn’t a narrative to follow. What I feel and think watching these dancers could be completely different from the person next to me.

Hubbard Street Dance Chicago
Image from TimeOutChicago.com

My mind had been racing the entire show. My thoughts drifted from the dancers and my fascination with their strong bodies and graceful movements, to thinking about the different relationships in my life at the moment: the ones I had, the ones that I wanted, and the ones that I had and didn’t want.

I looked around again. How many people in the audience were thinking about a fight that they had earlier? How many people were there celebrating some happy occasion? Who was dragged there by a significant other? I looked up at the dancers, moving perfectly together, each movement beautifully synchronized. I wondered if anyone in the audience had been moved to tears.

Feeling nostalgic, I thought about all the times in the past few years that I had been sitting in those very same seats watching this same dance company. I reflected on all the ways that my life had changed in those years, from where I lived, who I was dating, and whether I was in school. But I also considered all the ways that it was still the same. My mind then drifted to the current transitions that I’m going through and the uncertainties and anxiety surrounding them.

Then I felt it. The familiar feeling. My blood sugar was dropping. Waiting until the applause between dances, I opened the crinkling plastic of my fruit snack, pouring the contents out into my hand. It was a process that I had mastered over the years, sneaking fruit snacks while making as little noise as possible.

A lot has changed in my life, and a lot more is in the process of changing. But as I chewed my fruit snacks and admired the dancers, I found a strange comfort in the familiarity of my diabetes.

Shots all around!

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“What can I help you with today?”

The nurse sat across from me, pulling up my medical record on her computer.
“I’m here for my second MMR vaccine, I also was hoping to get my flu shot today,” I responded.
“Great, we can take care of both of those today.” The nurse handed me the vaccine information statements as she ran through the necessary list of questions before administering the vaccine. “We’ll do one in each arm, let’s start with the MMR vaccine (measles, mumps, and rubella). This one will go into the fat on the back of your arm.” 
“Well you won’t have any trouble finding a good spot then”, I thought to myself. I guess there are some benefits to missing my upper body workouts lately. 
I sat sideways in the chair, staring at the closed door. I could feel my heart rate quicken as she cleaned off the area of skin with an alcohol swab. Her cold fingers pinched my arm as I felt the needle penetrate my skin. “Just breathe,” I thought to myself. I felt the sharp pain as she pressed down on the syringe. “It’s almost over,” I repeated to myself. She pulled out the needle and placed a band aid over the site.
One down, one to go.
“I’m going to do the flu shot now. This one goes into the muscle and your arm may become sore. Just take some ibuprofen to help with the pain.” 
I switched around in the chair, bracing myself for what was coming next. I couldn’t watch so instead I focused straight ahead. I held my breath as she pushed the needle in. “Okay, just a few more seconds,” the nurse said. She pressed down and I cringed, shutting my eyes until I was sure the needle was removed. 
“Are you okay?” the nurse asked. She looked at me concerned. “Sorry, that one can be kind of painful.” 
“Yea I’m fine,” I responded as the color returned to my face from holding my breath. 
“That’s the last shot. You won’t need any more today. Are you sure you’re okay?”
I smirked.
“Yea thanks. I actually have type 1 diabetes so you’d think I’d be used to needles by now, but I still hate them. And unfortunately that won’t be my last needle today…”
The nurse gave me a sympathetic smile. I smiled in return and thanked her as I headed out the door. 
In one year I figured out that my skin gets punctured by around 1,600 needles. Over the 13 years that I’ve lived with diabetes that’s over 20,000 needles that I’ve dealt with! You’d think that 2 shots at the doctor wouldn’t bother me at all…if only that were true.

Sleep walking has nothing on Low walking

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BEEEEEP BEEEEEEP BEEEEEEEP

That incessant beeping. Make it stop!!

I rolled over. I could see the “LOW Under 55” flashing on Gig’s screen (my CGM). As I slowly started to come out of my sleepy state, I could feel the symptoms of my low becoming increasingly stronger. I felt around on my night stand for a pack of fruit snacks, knocking my water bottle and kleenex box on the floor in the process. I ripped the packet open, pouring the contents in my mouth still half asleep. What time is it? 3:34 am, great. I laid there chewing my fruit snacks when all the sudden I got this sudden craving for something crunchy.

I don’t have a ton of these type of lows, but there are some where I just become ravenously hungry. It wouldn’t matter if I just ate an entire Thanksgiving meal, these types of lows make it feel like I haven’t eaten in days. It was exactly what I was experiencing.

i'm hungry gif

I wanted an apple. I had to have it. I rolled out of bed. Disoriented from the low and from still being half asleep, I lumbered towards the door, running into my chair and tripping over the clothes on the floor. I felt like a zombie being compelled by a carnal need. Fooooooood. Must have fooooood.

I knew this low was bad. There are very few that get me out of bed and downstairs to the kitchen in the middle of the night. Now this is where low blood sugars can be dangerous for another reason. You literally want to eat everything in sight. And no, not just sugary foods, everything.

image

I stood in front of the open fridge. Where do I start?!

This is about the time where “Rational Reva” must have woken up and decided to join in.

“Woah woah woah. Put back that tub of ice cream. You can’t eat that whole thing. Do you know how many calories are in that?! Seriously.”

Ughhh fine. I took out a container of cut up watermelon. Binge eating watermelon is fine right?! After about the 10th piece I started to look around the kitchen for something else. Jackpot. I found a small baggie of Chicago mix popcorn- cheddar and carmel flavor. Before I knew it, the bag was empty. Maybe a few wheat thins. Ooooo junior mints, there’s a box in the freezer!

Rational Reva chimed in again. “You are going to feel sick. Do you realize what you just ate?? Cheese popcorn, watermelon and chocolate. Gross. AND you totally just ate way more carbs than you needed. You really should give some more insulin for all this food.”

Yea, yea. I took out my pump and bolused some amount of insulin and headed back upstairs to sleep. My stomach started grumbling, clearly it had enjoyed my super snack session less than I had. I somehow managed to fall back to sleep.

image

BUZZZZZ BUZZZZZ BUZZZZZZ

I awoke to the lovely buzzing of a high blood sugar. I picked up my CGM and saw a large spike in my blood sugar from my kitchen escapades hours earlier. So it wasn’t a dream. Well I guess that would explain the orange cheesy finger smears on my t-shirt. Maybe next time I should just stick with the apple.

One Annoyed Biker

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Dearest Gigi (Dexcom G4 CGM),

I apologize for how long it has been since we last talked, but really I saw our lack of communication as a good sign. Things were going so smoothly that I felt no need to address you personally…that is until recently. I think we both know what I am talking about, but allow me to refresh your memory.

It was the day of my big bike ride, 36.5 miles, an organized ride through the city of Detroit put on by the health system where I work. I had been training for weeks for it, building up for the long ride. I was prepared. I had plenty of fruit snacks and granola bars stored in every pocket in case I got low. In order to save room in my little bike pack, I decided to bring you, Gigi, and forego the bigger and bulkier finger prick glucose monitor. I figured you’d be perfect for this type of event. I could glance at you and see what my blood sugar was and if it was rising or falling. I wouldn’t even need to stop riding to check you. Plus you are so much smaller, you could easily fit in my pack.

My blood sugar had been running high, but I wasn’t worried. I knew that biking for 3 hours would drop it. I was just hoping that it wouldn’t drop too low while I was riding.

I checked you right before the ride started at 9 am. You were giving me the “out of range” sign, which made sense since I had walked away from you. The race started. You were stored under my seat in my bike pack. I didn’t think about you for the first 10 miles or so. Then I pulled you out to see what my blood sugar was doing. ???. You were giving me the question marks. Are you kidding me? Why weren’t you working Gigi?! I needed you. I had no other way to check my blood sugar on this ride.

I rode on. I paid attention to how I was feeling. When we got to the halfway point, I could hear you yelling at me from the pack. “Low, under 55.” I knew that wasn’t true, I didn’t feel low, let alone that low. I ate a banana and half a granola bar, but didn’t give any insulin. I didn’t know what my blood sugar was, and you couldn’t be trusted. You were suppose to tell me, Gigi! Maybe I should have eaten the whole granola bar. I didn’t know!

We were at 28 miles. I was starting to feel “off”. Was I dropping low or just getting tired? Gigi, you could have answered that question. I wanted to be safe so I ate a pack of fruit snacks and kept riding. We finally reached the end. It was a little after 12 pm.

Then the craziest thing happened. You started working! And you have been working fine ever since. But Gigi, where were you when I needed you the most?! It’s as if you were trying to spite me, working right before and right after my ride, but nothing in between. And you’ve worked fine on other bike rides, so I don’t know what your deal was today. Your behavior today was unacceptable. I’m disappointed in you and frankly kind of pissed off. Thankfully everything worked out fine, even without your help. You also reinforced the lesson to always bring back up. When I finally tested after lunch, I was 144.  But you completely abandoned your primary task and purpose and really let me down.

So no thanks to you Gigi, I successfully finished my first bike tour! All I can say is that next time, you better show up!
Sincerely,
One annoyed biker

Changing Life’s Lancet

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I’ve decided to start a new series of posts: Life Lessons Inspired by Diabetes (still working on a better title). I’m not entirely sure how these posts will pan out, but my plan is to take something related to my diabetes and derive a lesson that can be applied more generally. It’s more than what my diabetes has taught me, it’s the hidden lessons we can all learn from an unlikely source. So here goes the first one:

Ask most type 1 diabetics when the last time they changed their lancet was. For a lot of people, myself included, it could be over a month (possibly a few) since we last changed the needle used to prick our fingers. Why is that? That’s a good question.

I think for me, I get into a routine. Poking my finger becomes automatic, and changing the lancet becomes another step, one that I don’t typically think about. But consider this: the more you use a needle, the duller it becomes. And when it comes to needles, dull needles are actually more painful than sharp ones. So really it is in our best interest to switch things up, to replace an old dull needle with a new, sharp one. Yes it takes a little more effort and conscious thought, but in the end, it’s to your benefit.

Get rid of the dull.

Everyone has their routines. Routines can be comforting. They let you know what to expect so that you aren’t caught off guard or in an uncomfortable situation. They bring familiarity, safety, and peace of mind. But routines can get old. They can become boring. You can become stuck in your patterns and rituals and forget to step outside of the safe and familiar to try something new and different.

Leaving your comfort zone takes effort and thought. It’s not always easy to do. But like switching to a sharp needle, taking risks can introduce unforeseen benefits to your life. It opens you up to new possibilities and experiences. It teaches you new things. It enriches your life in ways that you can’t imagine, and it helps you grow as a person.

I’m not saying that all routines are bad, but take a moment to think about the areas in your life where the needle is starting to become dull. Maybe it’s time to change life’s lancet. I think you’ll be glad you did.

The Suspicious Symptoms

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It was the middle of the afternoon and I was spending my day off from work sitting next to my dad waiting for a movie to start. Prompted by the previews to silence your cell phone, I checked my CGM to see if I should be expecting it to vibrate during the movie. I wasn’t pleased with what I saw: it was 280 with an upward arrow. We had just gone to lunch before and was battling a high blood sugar (272), but I had prebolused a sufficient amount of insulin. The upward arrow had me concerned, but I put it away as the movie started.

Fifteen minutes passed and I discreetly checked again, hiding the bright light in my purse as to not disturb those around me (there weren’t many for a Thursday matinee).

305 and still rising. This wasn’t good. I was hoping that it would at least begin to level off or start dropping.

I began to worry, I didn’t want to correct too much just in case it was about to peak and then drop, but I decided to give some more insulin anyway.

I tried to focus on the movie, but every time I checked, my number continued to climb. 320, 350, 380, the number reached the top of the graph, reading HIGH, a number above the 400 that can be displayed on the CGM. Obviously my body isn’t getting any insulin, I thought.

I started to feel sick. I was nauseous as well as experiencing physical pains in my lower abdomen, something that happens sometimes when my blood sugar soars.

I started to run through my options in my mind:

  • I could tell my dad that we needed to leave since we drove together
  • I could call to see if someone could pick me up or bring me supplies to change my set
  • I could give more insulin and wait and see if it would start to come down on its own
  • Or I could use the insulin from my pump to give myself a shot. 

I stared at the screen and the dots that were now riding along the very top of the graph. I knew that I had syringes in my purse and decided that I would use the insulin in my pump to give a shot and then change my set when I got home.

I got up from the movie and walked to the bathroom. I sat down and took out my glucose meter to test my finger. If I was going to give a correction through an injection, I needed an exact number so I would know exactly how much insulin to give. I watched the meter count down, expecting a number somewhere in the 400s.

250. Wait, what?! That’s definitely not in the 400s, and that number is lower (although only slightly) from what I was before I ate lunch. Therefore, the insulin was in fact working. I decided not to give an injection and instead gave a correction through my pump. I went back to the theatre and sat down, slightly confused.

Were the symptoms I was feeling actually associated with my number of 260, or was there a placebo effect happening? Was thinking that I was in the 400s enough to cause me to feel the symptoms of that dramatic high?  While 260 is definitely too high, I don’t normally experience the type of symptoms that I was with that number.

Soon after, the down arrow on my pump appeared and I began to feel better. My blood sugar continued to drop throughout the course of the movie, leveling out right around 100.

Although there is often a discrepancy between my CGM and glucose meter, its rarely that large of a difference or that drastic of a high. I started to think back to how I was feeling earlier.

Was it possible that my physical symptoms were in fact psychological? I had watched on my CGM as my blood sugar gradually rose to over 400 and believed that it was true. Was that belief enough to make me experience those symptoms? I’m not sure. Research shows that people can feel better while taking placebo pills, merely because they believe the pill will help them. Was that what happened to me, but in reverse?

It’s an interesting phenomenon and question that I don’t know the answer to. I haven’t had the same kind of placebo effect since, but I’m curious if anyone else has had a similar experience.

The Michigan Ave Mystery March

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“Can I help you find something?”

“Urm well thatsh okay, I’m jush lorking, but shanks,” I mumbled with a mouth full of fruit snacks. Sometimes when I get really low, as I was at this moment, I pour the entire contents of the pouch into my mouth at once. Struggling to form a coherent sentence, mouth full, and teeth sticking together, I can only imagine what the woman must have been thinking as she gave me a curious look before walking away to help someone else.

Lost amongst the racks of clothes, I managed to make my way out of the store and outside. There I stood in the middle of Michigan Avenue in downtown Chicago.

There are all different kinds of low blood sugars. Some can feel much worse than others, even when they are the same number. I was experiencing one of the bad ones. In fact, both of my legs had started to tingle and feel kind of numb. What a strange and unpleasant experience to say the least.

I was alone. My friend was sitting in a coffee shop a good 4 blocks away. Not that she could do anything to help me right now. Plus I wasn’t worried. I knew that in about 12 more minutes, I would begin to feel normal again. It is just this waiting period that is the worst.

So hands shaking, head spinning, legs tingling, brain not quite thinking straight, I decided to walk. Where to? I’m not sure. I just focused on putting one foot in front of the other.

“Oh wow,” I thought. “This feels weird to walk when my legs are tingling. I wonder why they are tingling, what does that have to do with low blood sugar? Oh I like that girl’s dress! I wonder where she got it. It probably wouldn’t look like that on me though. Plus it’s almost fall, it’s going to be too cold for dresses like that soon. I wonder how many people are out shopping right now. Are there more or less because it’s Labor Day?”

Lost in thought, I had no idea where my legs were taking me until I stopped in front of a door. I looked up at the sign to see where I had walked to:

Hershey’s Chocolate Company


I laughed to myself. Naturally this is where I would end up with low blood sugar 🙂

Strip Safely & Diabetes Art Day: Strip Tease

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Diabetes Art Day has collaborated with the Strip Safely initiative to raise awareness about the issue of test strip accuracy. As stated on the website, “The goal is to collect a body of images that capture the emotional experience of relying on inaccurate test strips to make decisions about food, activity and medication that affect our immediate and long term health outcomes.”While the campaign urges people to send letters and use social media to get the message out, Lee Ann, the person behind Diabetes Art Day, recognizes that printed letters just does not capture and convey the emotion the way visual art can.
Inaccurate test strips is a huge problem, putting diabetic’s health and wellbeing at risk. We need more stringent accuracy requirements and the proper process to remove those that don’t meet this standard. It’s an issue that people need to know about. This edition of Diabetes Art Day is working to do just that, to bring awareness to this important issue so that action may be taken to ensure test strips and meters meet regulatory requirements.
My artwork for this Diabetes Art Day plays off the words, “Strip Tease”. While there is some humor involved, it points to the important issue of using test strips that are safe and accurate rather than those that may be deceiving and therefore harmful.

You can check out the gallery of images for this special Strip Safely Diabetes Art Day here.