Comparing CGMs to Crayons…

The start of this adventure was back in December of 2008 after I started on my OmniPod system. I was getting much better control with this pump because, unlike my prior pump, this one had things like “Insulin on Board”, “Bolus Calculator”, and all that good stuff, not to mention, it was the perfect, closed loop system in my opinion because the PDM had the built in monitor as well. Everything could be kept in a neat, nice little pouch inside of my purse.

Well, as always with getting better, lower numbers, you also get more of the not so good, lower low numbers as well. I could deal with them at the time because there were only a few per week, or I’d only have one really bad day in the week where they just wouldn’t come up. But as with any time you make adjustments to lower the still-high-highs, you are more prone to getting the lows. Well, over time, I am losing the ability to tell when I am dropping low. It’s not quite as bad as some, but where I used to be able to feel a low coming on in the 80-70 range, it’s now down to the 50-40 range, and that, to me, is scary. I have a fear that I will drop too low and not be able to tell anyone what is happening or what to do. I’ve heard many of the horror stories of people passing out, and I have done so myself, and that is something I do not wish to revisit again. So, I decided to apply for a Freestyle Navigator CGM. I chose this one because it would take the same strips as my OmniPod PDM. We filed the paperwork, hassled with my unwilling doctor to get the papers signed, and waited for approval.

The weeks went by and finally I got a call from Abbott that said my insurance had denied my request due to lack of medical necessity. Okay, first off, I would like to know what doctor read my file and said that I, a diabetic of 20+ years, could not show evidence through my testing that I needed a CGM. It’s kind of like when you are a kid and you want to get crayons from the store. You want the best… you want Crayola. But your mom says, “no, these are just as good”, and gets you the dollar store waxy crayons that when you color with them, you get more wax than color on your paper. You are asking the insurance company for the Crayola… The insurance company basically says no and gives you the waxy crayon… They say “No, you can manage your glucose just as well with only doing 8-10 checks a day as opposed to having 288 readings per day, and you should have no problem attaining a great A1C to reflect it.” We were going to file for an appeal, but I never received the papers in the mail. I decided just to give it a rest and try to do my best on my own. Since then, the aim for tighter numbers has given me more lows, still in the 50-40 range, but with less symptoms than before, and also leaving me with killer headaches. Ones that have even recently caused me to lose time work because they would physically make me too sick to work. I looked over my readings on my CoPilot system, and it showed a LOT of lows in the below 50 range happening more frequently than before, most of them unnoticed…

I submitted paperwork back on the 11th of this month to Dexcom to try for their 7Plus CGM since there are reports that they are teaming up with Insulet to somehow integrate the two systems. This morning, the representative informed me that they have already verified my benefits, and were waiting on a fax from my doctors office (a new doctor, due to problems with my old doctor, we switched. That will be covered in another blog. My new one is much better and is in favor of and promotes CGMs as well), then they were submitting everything they had to my insurance company for preauthorization. So the wait begins. I am hopeful… wishful… and am being as patient as I can possibly be right now.

A1c Countdown

 So, as a diabetic, we know that every three months the wonderful a1c test rolls around to tell our doctors how we have been doing since our last visit three months prior.

I always dreaded my a1c tests. I would do anything to get out of going. Fake sick, be out of town, absolutely could not get out of work that day… all because I knew when I went, I would have a high result. I would even try to cram in the best numbers I could get the month before the visit so my doctor wouldn’t fuss for me not having enough readings ( I would actually go an entire week without testing at times before this month came!!! AAAH!!) and causing the high numbers. And truth be known, I was just in denial of what was really going on. I was diabetic, always had been, I just didn’t want to be. I thought if I just ignored it, it wouldn’t matter and I’d be just fine. After all, I had lived this long, why would anything happen to me if I continued on? Well, I am here to say that I was terribly wrong. You can’t hide from diabetes, it’s a part of you. You can’t ignore it, it will let itself be known one way or another. When I finally opened my eyes, I realized what I was doing to myself. I didn’t know just how terrible I felt everyday until I started doing what I was supposed to do. I also didn’t realize the damage that was being done…

My turning point came after I turned 23 (19 years post-diagnosis). After being married for a few months, conversations started to lead to the subject of pregnancy at some point in the next few years. I knew I had always been told that your a1c has to be perfect before getting pregnant, so I started testing and doing as told. Now, my a1c is not perfect, but it is improving.  The damage that was being done has reversed. The tables of diabetes are being turned. I am now controlling my diabetes, it’s not controlling me. The biggest improvement is that now, I look forward to my doctor visits and a1c tests. I even have a countdown clock on my computer desktop that tells me how many days I have left to go until the next appointment and test. I am excited and have fingers crossed that it will be better than the last one. I may not be on target yet, but if I’m even just a smidge closer or even right where I was last time, I will see it as having done a good job. And if it’s higher, I may throw a little fit at first, but I will pick myself up and start my countdown again. Life is too precious to not take care of yourself and enjoy it.

By the way, as of today, I have 31 one days left on my countdown. Check back in late September for the result!

The diabetic pincushions

This week has been rather challenging for me. Other than the normal stresses of work and family, diabetes has decided to really throw me for a loop.

The past few weeks, looking over my CoPilot software that I upload my PDM to, I have had quite a number of “green numbers” (you know, the good ones…. the ones that fall within range). Yes, there have been a few outside of it, but it is a very exciting thing to see when you upload your readings to find yourself looking at a sea of green blocks showing how good you have managed yourself recently.

Well, that streak ended yesterday morning. I did my usual routine of getting up and getting ready for work, checking glucose before breakfast only to be shocked to see “341mg/dl” come on my screen in big bold numbers. I was very upset to say the least. I changed my insulin pod, corrected and decided to wait a few hours before eating breakfast to be sure the ghastly number was on it’s way down. I was finally getting really hungry, so I checked at the two hour marker only to be further disappointed with a 374mg/dl!! I could not believe what I was seeing! My mouth literally fell open! What is going on here? Thought to myself, well, maybe the pod change is just delaying the absorption a little, I’ll wait a little longer…. 398mg/dl was the next reading. By this time, I had enough of the highs and removed the pod and went on pen shots. Took my Lantus for basal and Apidra for correction and went about my business. By the end of the day, after my fingers felt sore from all the pricking and checking every hour or so, I was back to normal (or close enough to it) that I thought, “FINALLY, we’re out of the woods!”….

Not so. This morning, once again, bg was 300mg/dl. “WHAT? NOT THIS AGAIN”, I thought to myself. “Why” was the only question that was crossing my mind. I thought I had fixed it. I went on the pens… carefully took the right amount at each poke of the needle… bg was great before bed. So, I did the same as yesterday, I tried to postpone breakfast to see if it would come down after a correction shot… and it did, some. 237 was my number after waiting an hour. Being very aggravated and hungry at this point, I decided to eat a light snack. 2 hours later, I’m back at 317… 30 minutes later, 310…. not much was changing and I was getting sick. That icky feeling you get when your glucose is high for too long. I had enough. I called the doctors office and got a call back in an hour asking me to come in. He looked at everything, checked me out for sickness, and could not conclude what was going on either, so we bumped up my basal rates and we’re changing my insulin brand to Novolog at my next pod change. He attributes the highs to heat. It is possible, so we’ll see I guess. Bg did finally reach 152, but is going back up. Currently at 178mg/dl. So with the insulin resistance going in high gear these few days, I may be switching back to pens and changing a few other factors (like insulin to carb ratios, correction factors, that kind of thing) until this wave is over.

Looking at my fingers and my arm, I look as if I have been made into a pincushion. All of my fingers have little freckles from all the pokes and my arms have tiny little bruise spots from the shots. It reminds me a lot of how a pincushion looks after a seamstress has used one a few times with all the new holes left from the needles being stuck in it. Of course, they get worn after a while and you can’t tell it, but it’s the new ones you can really see it on. This week, I have used fingers I usually don’t use to test with.. they are my little pincushions… the diabetic’s pincushions.

When did my handbag become a diabetic gadget holder?

Growing up, as a little girl, you are taught (or I was anyway) not to carry things in your pockets that would make them bulge (otherwise, nothing more than a few pieces of paper… maybe). You were told to carry a pocketbook. Of course, I know this was certainly nothing new when I was born. Way back when it all started, the accepted practice was a sack or bag of some sort to carry money, and used by both men and women as there were no pants to have pockets in back in the day. With the invention of pants pockets, men no longer needed the little sacks, but it stuck around through the old days when it was completely unacceptable for women to wear pants and they could only wear skirts (which is still true in some cultures). The bags were small, lacy, handmade wristlets to carry their things, mainly money, but also included things like the much needed hanky. And even when pants became popular with women, for some reason, then handbag stuck with us women. Since then, girls have been taught to carry their handbag, purse, pocketbook, or whatever you called that bag you carried around with all of your can’t-leave-home-without things. That way, you could always just pick it up and go or set it down when you come back. No filling/emptying pockets all the time. There was always the checklist of the most important things: keys, cash, compact, lipstick/gloss, pen, tissues, and gum, to name a few. The list changes from person to person, of course.

Well, being diabetic, you also had to include your trusty meter, pricker, strips, lancets, alcohol wipes and glucose tablets. As the time has passed for me, a few things have been added to my list. Not only do I have those same things as before, I also have the OmniPod PDM, extra batteries, an extra emergency vial of strips (I’m so forgetful sometimes!!), vial of insulin, and spare pod. Other non-diabetic things are a spare pair of glasses for when the contacts just cannot be worn for some reason. I can even fit my hubby’s electronic accessories when needed (i.e., iPod, Blackberry, pager, keys, and anything else he may hand me). It’s amazing to me that when I pick up my handbag, that I know that everything is there just by the weight of the thing. If it’s too light, normally I have forgotten to put my phone or PDM back in it.

I know that my checklist is a little different than most women’s. Lately, even though I have a lot of the normal stuff in there, it seems when I look in my bag, it is a walking diabetic pharmacy. I have tried to cut down on the amount of things or even the size of things (going with a smaller pricker, only carrying one vial of strips, carrying Airhead candy instead of a tube of glucose tabs, not carrying the extra insulin vial or extra pod), but it seems I always go back and put all of those things back in there. Then it hit me today… my bag has turned into my own personal diabetic gadget bag. I would be absolutely lost without it! Up the creek with out my paddle…lots of fries short of my happymeal… you get the picture.

Small bags are out of the question for me… always have been, pretty much. I am so glad that the larger bags are in style right now. And even if they weren’t, I think they’d just have to be my “fashion statement”. After all, a girl’s gotta do what a girl’s gotta do… diabetic ones included!

To Have Pizza or Not To Have Pizza??

Sunday night, my hubby and I went to my sister in law’s house because they were getting rid of some extra furniture and I needed a desk, so we were more than happy to take it off of their hands. (They also have us a bookshelf too, so I was excited!) They had ordered two pizzas, pasta, and breadsticks from Pizza Hut for us all to eat while watching TV before leaving to take the furniture home. I thought to myself, “Okay, I can do this… Just get one slice of pizza, 1/2 a breadstick, and just a taste of the pasta just to not be rude.(yeah, right, who am I kiddin?)”… WEEELLLL, here’s how it went…

We sat watching Judge Judy (wonderful tv show!) and with Diet Mountain Dew in hand, I ate every last bite… and did so rather quickly. It had been a while since I let myself enjoy this wonderful junk food since trying to get my glucose numbers under better control. But as soon as I started, the taste overwhelmed me… the wonderful cheesy, saucy pepperoni pizza, cheesy breadstick, and oh-so-wonderful ham pasta alfredo was simply wonderful! I know it may not be THAT appetizing to some since it only came from Pizza Hut and not some fancy pizzaria, but to me, it was “the best thing since sliced bread”. I tried my best to limit myself, but pretty soon, I REALLY wanted another slice… and of course, it being offered to me didn’t help my willpower any more either. So, yes, I gave in… Doubled what I had intended on eating. And BG showed it later too… 258 BG at beadtime check. OH! I could kick myself! But, the damage is done… may as well correct and watch myself for the next few hours for possible hypos.

The New OmniPod PDM200: My Personal Review

Hi all!
I just received my new PDM upgrade recently and am completely excited. After playing with it for a few days now, I thought I may post a blog that would explain from my point of view the different upgrades, good and bad, between the first PDM and the new PDM.

The new PDM is a dark, almost navy blue color and is shaped more like a standard PDA. As far as size, it seems slightly thinner, but it is slightly longer as well. Not too bad though. It’s about the same size as my blackberry curve, just a tad bit thinner. In my opinion, it has been redesigned that way to follow their slogan "Making diabetes a smaller part of life" so that other people think it really is a PDA, not an insulin pump controller and you’re just planning your agenda, not your insulin intake. The screen is now larger than the old PDM’s screen, making more room for menu items on the much easier to nagivate Home screen and new Status screen, which now has all the needed information about the pod on one screen, not two as the old PDM had. Besides the increased screen size, I do believe the best upgrade was making it in color. The resolution makes the words clearer and the white background makes the screen brighter and easier to read than the prior PDM’s black-on-grey screen.

However, since the screen is bigger, the buttons are smaller. Instead of the seven buttons, there is now only an oval with 4 buttons below the standard three control buttons. On this oval, there is the up button on top, down button on bottom, home/power button to the left side and the (?) help button on the right side. These buttons are slightly harder to press, but I attribute this to the smaller size of the button and also safty reasons as to prevent an accidental bolus. The food database no longer has it’s own button, but has been moved to the home screen, as well as the glucose history. They have also added a little port light at the bottom of the PDM where the strip is placed for glucose checks. This helps to make sure you put the blood sample in the right spot if you happen to be in a low-lighted area. This can only be activated after inserting the strip and pressing the middle control button when prompted. The port is easy to find on the bottom of the PDM, so it shouldn’t be a problem putting it in, but if you’re like me and do several midnight glucose checks some weeks, you really need that port light to be sure you’re getting your sample where it’s needed.

Now, as for setting up the PDM, it’s very similar to the old PDM, with one exception. After you get it set up with your basal rates and you activate your new pod with it, you cannot use bolus calculations until your insulin duration time has passed. i.e., if you have an insulin duration of 2 hours, and you activate your pdm at 12pm, you cannot use the bolus calculations until after 2pm. Likewise, if you have a duration of 4 hours, you cannot use it until 4pm. This is to prevent a possible low from insulin on board that the pdm is not aware of. This is only for the first time you use the pdm, not every time you change the pod.

I really like the case they have provided with it. Everything fits right inside and is easily accessible.It has a guide inside as to where to put everything, but it has slots for the PDM, pricker, insulin, strips, 2 extra batteries, alcohol wipes, spare meter, and the back has a pocket for an extra pod. I usually hate cases, but this one I like. I may stick with it for a while.The front is plain with the OmniPod logo at the bottom right hand corner, kinda like the case that came with the first PDM.

They are going to be sending out the clear gel case too for the pdm since mine wasn’t included in my shipment (they said a few slipped through without the links for the software online and the gel cases, hence the delay if you haven’t gotten yours yet.)I heard through the internet grapevine that it will be a clip style skin/case, but we’ll see when I get it. I’ll post pictures when I receive it.

Since they have gone together with Abbott to make the extension for Abbott’s CoPilot system, you can download a copy of the CoPilot software from Abbott and download the extension (or Plug in) from OmniPod. I had trouble downloading it, but I found out it was my virus scan that was causing it. Just go to www.myomnipod.com and go to the Customer Care section. To the left hand side, there will be a Downloads section that you can download the programs from it. Download and install CoPilot first, then the Omnipod Extension. One problem I did run into is that I kept getting an error while the program was running (stating I did not have any virtual memory available, which I know was not true), so I had to close the program and run it in Windows XP compatibility mode. (I have Windows Vista). All you have to do is right click the program, go to properties, click on the compatibility tab, check the box for Windows XP SP2, apply and close. Reopen the program and you shouldn’t have those errors pop up. Getting readings is VERY easy. I have uploaded my new PDM several times since receiving it and it literally takes one minute. Just open the CoPilot software, plug in the pdm, go back to your Copilot software, click on the data entry tab, and click read from Omnipod. It should import everything, but word of caution, it only downloads up to the day before. This is what I had when I first got the PDM:

The software also lets you get a settings report from the PDM by going to the Omnipod tab and choosing Omnipod PDM Settings Report. Click it, give it a second, and this is what you get… Great thing to have in hand when you’re at the doctors office so you don’t have to look through the PDM each time they ask.

As of now, I am completely and utterly in LOVE with their new system. It is a great improvement over what they had before, which was hard to imagine because I thought the old PDM was great too and didn’t think they could improve much more… BOY was I proven wrong! The only thing that I can say I don’t like is how loud they have made the beeps. It is much louder than the first PDM. If I could have my way, they would have made it with different volume levels or an option for sound or vibrate so that you could avoid embarrasing situations like sitting in a meeting or in church and your PDM alarming really loud.

In conclusion, the new and improved PDM is a wonderful upgrade and would certainly, without a doubt, recommend it to anyone that either has the old PDM or would like to upgrade from their traditional tubbed insulin pump. If you are currently with OmniPod and have the first PDM, you may want to consider upgrading. The offer to upgrade for $149 ends in September, so do try to order before then to avoid paying the standard upgrade price. Not only that, you also get to keep your first PDM as your "backup" if something were to happen to the new one. Thanks for reading my review of the OmniPod PDM200.

Happy podding!!!

Thinkng of Baby… Maybe, Maybe Not

Today, my mind decides to play visions of a happy little baby/toddler in mine and my husband’s life. Thinking of how it would be having a “daddy’s little girl” in a cute pink dress sitting in his lap, or walking around trying to reach up to us to hold her. Or maybe a little boy… “Little E” (my husband’s nickname is “Big E” because he’s 6’3″ former college football player) running around with toy Transformers (my husband’s favorite cartoon growing up… still collects the toys from it) or going hunting/fishing/whatever with Uncle Alex and coming home to tell me all about the “BIG BUCK” they saw.

Only problem is, we don’t have that baby neither here or on the way. With my A1c not being on target for pregnancy, and trying everything in our power not to get pregnant, it seems to be that one thing that I want but can’t have. And it’s not like a new house or new car, but just that part of me that wants to be complete… that part of me that my cats can’t take the place of. Although with times as they are with the recession and all, it’s probably not the wisest thing to do right now. And yes, I know, that when the time is right, God will make a way for us to be able to have our little munchkin.

So, until then, I have my goal to work on for my A1c and two loving cats to be my babies.