You may recall that back in March 2011, there was a huge recall on IV Prep pads that many people with diabetes used to prep an infusion site location.  Since that recall there was a substitute that my supplier recommend that was just OK.  The Skin Prep pads were just too thin on the liquid that would make it drip when taking it out of the package.  I think the Skin Prep was somewhat effective, but I didn’t notice much difference than simply not using anything.

Fast forward to today when I called my supplier to get a re-up (“The Wire” reference) on insulin pump supplies and just happen to ask if they had IV Prep back.  Here’s how it went:

Me: “Do you have IV Prep again?”

Her: “Yes, we have it back and it’s safe to distribute.”

Me [thinking]: Uhh yeah, I don’t need to know if you have unsafe supplies just to taunt customers.

Me: “Oh great!”  “How many can I get?”

Her: “You are allowed to order 100?”

Me: “SWEET JESUS 100 BOXES????”

Her [laughing]: “Uh no, 100 or two boxes of 50.”

Me: “Yeah, that probably makes more sense huh.  Sign me up for 100.”

So there you have it.  IV Prep is back and I’m stocking up STAT.  I’m totally out of Skin Prep and IV Prep, so it comes at a great time.  I actually called my supplier simply to get more Skin Prep and came out with IV Prep.  Sweet!

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I want to sincerely thank you for your continued support. This blog is better because of you.

IV Prep Is Back! is a post from: Blogging Diabetes

My Medtronic Pump

I have been using a Medtronic Minimed 715 insulin pump for the last 5.5 years.  I believe the warranty is only for 3 or 4 years, which means if mine breaks now I need to pay for a new one (insurance copay).  If it was under warranty I would probably be able to get a new one from Medtronic at zero cost.  The Rep for Medtronic told me that it’s beneficial to have the pump under warranty in the event it breaks I can get a new one a little quicker due to paperwork that will be needed.  I get that and haven’t wanted to spend the money on a new pump since mine works perfectly fine and it’s over a grand for a new one.

Decision

I am starting to plan for 2012 and potentially using my Flexible Spending account to get a new pump.  I’ve really been thinking through what pump I want to get and it hasn’t been easy.  For the record, I’m still undecided and don’t know which way I will go at this point.  Here are the features that I like/dislike about each that are factoring into my decision.

Animas Ping

I’ve really been looking hard at the Ping.  The big features I like about the Ping is that A) It’s waterproof – like really waterproof to the point where I could jump in a pool fully submerged without issue. B) It’s pretty cool looking with a color screen (lower on my priority list) and finally C) They are working on integration with DexCom a leader in the continuous glucose monitor (CGM) market.  I might take the plunge down the road on a CGM and I think I would prefer a Dexcom over the Medtronic CGM.

I know it sounds weird, but the waterproof feature is almost a game-changer for me.  I don’t go on vacation or to the pool often, but it would be SO NICE to not have to disconnect my infusion set each time I went in the pool.  That also means more checking, tweaking of bolus/basal for time disconnected.  The waterproof feature is big to me.  Note, the Medtronic Rep made a good point to combat the fact that their pump is NOT waterproof.  He said, do you really want to take the chance with a $6,000 medical device?  They focus on features that will help patients manage their diabetes versus making it waterproof.

Medtronic Revel

Now with Medtronic, I get a company that is focused and built a strong reputation with it’s insulin pump.  My pump has worked very well for 5+ years and when I did have an issue, Medtronic responded quickly and resolved the situation perfectly.  I also have CareLink, my web-based program that has tracked my diabetes data for a long time now and works well.  My doctor likes the reports it produces and I like studying them for potential changes.

I have all the infusion sets and reservoirs that are for Medtronic, which isn’t a huge issue but a pain for timing a change.  The downside is that the Revel and CGM from Medtronic is not as good as the Dexcom from what I’ve heard.  They are working on changes and making the sensor more comfortable for insertion, but not there yet.  With a somewhat lean body type and goal of getting leaner, the size of the needle can be an issue.

Summary

As I previously wrote, it’s difficult to get an unbiased comparison from a pump manufacturer.  This is a pretty tough decision because it’s one I will have to live with for probably at least 5 more years.  Which company do I think will be better over those 5 years, what product will have better support and what will I be happier with?  Basically I am weighing the waterproof and change aspect of the Animas Ping against the proven support and product quality of Medtronic.  It’s a tough decision that I will continue to think through over the coming months.

Ping

+ Waterproof, CGM Integration coming and looks

- Untested/unknown customer support, change from what I’m use to, 2 devices if I want a CGM now

Revel

+ Proven performance, customer support, Carelink reporting, CGM integrated with pump

- Not waterproof, CGM inferior

Any suggestions, info or thoughts would be greatly appreciated – please leave your thoughts below.

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I want to sincerely thank you for your continued support. This blog is better because of you.

Medtronic or Animas Insulin Pump is a post from: Blogging Diabetes

This past January I hit my 5 year anniversary for being on an insulin pump.  Yes, there are advantages and disadvantages to being on an insulin pump, but I don’t want to get rid of mine anytime soon.  I’m starting to think about my next pump as mine is currently out of warranty and I’m dedicating some time to really thinking  through what company I want to go with.  For the purposes of this post, I’m only considering three companies: Animas, Medtronic and OmniPod.  I’m not making my final decision for some time as I will probably use my flexible spending account in 2012 to get my next one so I save about 1/3 of the cost through tax savings.

Not About Me

This post isn’t about what I want for a pump or what company I’m going to go with in 2012.  This post is about the biased representation that each of the three companies below show when trying to sell their pump.  Let me give you my two cents, there is no perfect pump or perfect CGM.  It really comes down to personal preference and what’s the most important feature you need and which one provides it for you. 

Medtronic Revel

The first comparison I looked at was on Medtronic’s Minimed site.   At first glance, the Revel pump looks amazing, especially if it’s for a child or teenager because you get the “Pediatric Friendly Features”. What the heck does “limited” actually mean for the Ping pump in this category?  For the OmniPod, this comparison looks like they don’t offer much, right?  If you click on the source below the image you can scroll to see some additional comparisons.  One that made me laugh is where the Revel and Ping are approved for active lifestyles, but not the OmniPod, which is ridiculous.  I know a few young adults/kids with this pump and it works out great for them.

Question – Why doesn’t Medtronic list if their pump is waterproof? That’s because it isn’t and the others are.  Biased and not objective.

[Source: Minimed site]

Animas Ping

The next site is Animas who makes the Ping pump.  Look at their picture to the left where they SELL the fact that their pump is waterproof.  Let’s look at the other two pumps in terms of waterproofing.  Minimed is splash resistent.  What the hell does that mean?  Can it get rained on?  What if I get squirted by a water gun?  Can I jump in the pool? Can I shower with it on?  I really have no idea and still don’t know the limitations of my pump after 5 years.  For OmniPod, it says it’s “watertight up to 25 ft for 60 mins”.  Isn’t that the same thing as waterproof?  What happens if you’re in the pool for 61 minutes?

I can’t speak to the Revel, but my Minimed pump runs on super lithium batteries and they last for at least 6 weeks.  Yet this comparison shows only the Ping taking Lithium batteries. Huh?

[Source: Animas site]

OmniPod

The big plus to OmniPod is that it’s wireless.  Trust me, if you’ve ever been on a pump before you will know that doorknobs attract infusion set tubing like bees to honey.   But now let’s look at the “Auto Insertion” option.  Again, I can’t speak to the others, but my Minimed pump comes with an auto inserter that pushes the infusion set into my skin with the push of a button.  I guess you do actually see a needle and have to somewhat handle it, but it’s a little misleading.   Another interesting comparison is the last one where I guess only the OmniPod is small and lightweight.  How do they actually define what is considered small and lightweight?  That seems to be pretty subjective in my opinion.

[Source: OmniPod Site]

Conclusion

The point here is that each company is going to market their best options and show how their pump is “better” than the others who do not have these great options.  The reality is you may need to talk to actual people who have the pump and see what they like and dislike.  The only word of caution there is that those people may actually be biased based on what they own.  I know a few people who are the type that everything they own is the best.

QOTP (question of the post) – What resource would you use to help pick your next or first insulin pump?

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I want to sincerely thank you for your continued support. This blog is better because of you.

The Truth About Insulin Pump Comparisons is a post from: Blogging Diabetes

Call me lazy, but I needed to have a second OneTouch UltraLink.  The benefit this meter has is that it communicates via wireless to my Medtronic Pump (715).  This is key because I use my pump to upload data to Medtronic’s CareLink site for reporting to my doctor and my own analysis.

What’s happened in the past is that my mid-day numbers were not complete because I was using the mini to test around lunch.  There’s no way I would manually enter numbers either.  That’s way too much work.  So now I have an UltraLink I use at home and one I leave at work.  No more being without my meter and no more missing data.

I will say that it was a complete pain in the butt getting this meter.  My pump supply company didn’t have any, CVS didn’t have any and both said they couldn’t order them.  WHY? I really have no idea.  My Medtronic Rep just happen to call and he put me in touch with the Inventory folks who I ordered it from.  Let me be completely transparent, I paid full price for the UltraLink meter, $89.99.

Why OneTouch doesn’t partner with Medtonic and just give these away, I don’t know.  Everybody knows the money is in the test strips.  If I use 6 strips a day and a box costs $50, that’s $2,200 per year.  Someone who is a lifetime customer could spend A LOT of money with OneTouch.  Who cares about the initial $90.  And, why make it so hard to get one of these meters?

After just a slight improvement in my last A1c, I plan to study my results on a more regular basis.  Having a second meter and the data I will now have will be worth the $90 I paid.  Now if you are on a tight budget, you can just get one and use it all the time.  I plan to only use my OneTouch Mini when I’m out and about.

One Sample – 3 Different Results

If you look closely you will see that the times are different, but that’s because I’ve been lazy about setting them.  You can be assured that I used one blood sample and tested with all three meters within seconds of each other.  It’s interesting that the OneTouch Mini to UltraLink on the right is about a 14% difference.  Running this test really just reminded me that I need to have the meters in sync, time wise, so when I upload the data to CareLink it will be accurate.  Also, this begs the question – could a 60 really be 48 or maybe 72?  Big difference.

How many meters do you have and which one do you like best?

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I want to sincerely thank you for your continued support. This blog is better because of you.

Don’t Wait As Long As Me To Double Up is a post from: Blogging Diabetes

If you are a subscriber to my newsletter you would know that right before Christmas I started on P90x.  It’s been over two full weeks that I’ve done the extreme fitness program.  The nagging impingement in my shoulder that started last summer came back after getting my cortisone shot in September.  Since around November, the shoulder has felt “funny” and I know something isn’t quite right.  Simply put, I am putting my shoulder ahead of my diabetes.

The reason I’m putting my shoulder first is two fold.  First, it’s kind of painful when I make certain movements and I get annoyed with it especially when I’m trying to play with my kids.  I tell myself that I’m too young to live with the pain.  Secondly, If I can continue to workout I will feel better, look better and have better blood sugar control.  Since starting the P90x, my blood sugars have been off the charts good.  I mean between 70-140 almost all the time.  Also, I was able to drastically reduce my basal rate and overall insulin intake.  The best part is that I’ve avoided having a lot of low blood sugars probably due to just dumb luck.

I foresee a Dexcom or other CGM in my future, but for now it’s all about getting ripped, taking care of myself and getting healthy.  I’ve entered 2011 with the goal for the year to be all around getting myself healthy and injury free, which means fixing my shoulder and continuing the exercise.  A CGM might help me control my sugar levels, but exercising does so much more.

The MRI on my shoulder was this past Wednesday and I go back next week to find out the results/verdict.  My fingers AND toes are double crossed.

P.S. GTPWD (Guess that person with diabetes) will be back starting next week

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I want to sincerely thank you for your continued support. This blog is better because of you.

Why I Put Dexcom On Hold is a post from: Blogging Diabetes

What has held me back so far is the high cost of the monitor and ongoing sensors as well as the fact that it’s an additional infusion-like site.  I wanted to wait until some company figured out how to integrate the pump infusion site with a blood glucose sensor so I only have to have one site.  At a minimum, at least Medtronic has the monitor built into the insulin pump so there’s no need for an additional monitor/meter on my body.

With Medtronic being out in the lead before I even dig into the options and details of the monitors, I find a lot of the diabetic’s I interact with use the Dexcom monitor even when they already have a Medtronic pump.  The Dexcom must be pretty fantastic if MiniMed users are foregoing the integrated pump/monitor, which has me perplexed.

There have been a lot of great comments on the facebook fan page, which you can check out by clicking here.

Stay tuned for more on this subject soon.  Any feedback would be appreciated, which you could leave in the comments section below.

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I want to sincerely thank you for your continued support. This blog is better because of you.

Continuous Glucose Monitor (CGM) Discussion is a post from: Blogging Diabetes

[Source]

I sometimes long for the freedom of no tubing or infusion sets.  I wonder what life would really be like if i was cured.  How long would I continue to test my blood sugar after being cured out of habit or curiosity?  When I am in between infusion sets and showering it’s the best feeling.  I don’t have to worry about the infusion set getting attacked by the towels’ strands. I know I digress, so I’ll get to my point of this post.

There will always be syringes in my house for two very good reasons. 

1. They are a backup for the time when/if my insulin pump dies
2. I use them very effectively for correcting my blood sugar

Anytime my blood sugar is over 300 I will almost always use a syringe to correct it.  I have found through experience that an injection in a different area than the infusion set will bring my blood sugar down faster than a corrective bolus any day of the week and twice on Sunday.  I imagine it that when I am bolusing and infusing insulin in one area, it can tend to get pooled up before it is absorbed.  If I eat a lot of carbs, bolus and then find I am still high, I find it more effective to inject into a different site.

Another benefit of using a syringe is that you take out the unknown of a bad infusion site, pump problems, reservoir problems, bleed backs, gusher, etc.  I know that when I inject the insulin my blood sugar WILL come down.  If I enter a corrective bolus, it’s a crap shoot.  When my blood sugar is really jacked up, I might inject about 70% of the corrective dose while bolusing for the other 30%.

Maybe this is a no brainer and you haven’t even read this far into the post.  Maybe you don’t even have an insulin pump. Quite possibly you don’t even have diabetes.  But if you didn’t know, now you do. A box of 100 syringes has lasted me literally years and only set me back about a $20 co-pay.  It is so worth the money and you will always find some in my case or home.

If you pump insulin, do you correct the same way or do you rely on your pump?

Like what you see here?  Check out our new Facebook page for more tips and insights into real-living with diabetes.

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I want to sincerely thank you for your continued support. This blog is better because of you.

Pumping Insulin: Keep Those Syringes Close By is a post from: Blogging Diabetes

Warnings

"Remove the needle guard before inserting the infusion set." – Um, really?  Maybe that’s why I…. never mind. 

"The soft cannula must always be completely inserted to receive the full amount of medication." – So I can get a partial amount  [dose] if it’s not inserted?

"If the infusion site becomes inflamed, replace the new set, and use a new site until the first site has healed." – Really, so I shouldn’t stick it directly back into the site where I just had a gusher?

"For Paradigm users, do not use the infusion set if the tubing connector needle had been damaged." – Don’t they know it’s a personal challenge to unbend the needle so as to not waste the set.

"If infusing insulin, carefully monitor your blood glucose levels when disconnecting and after reconnecting." – Um, what else am I going to infuse?

On a more serious note, the very last paragraph says, "If infusing insulin, do not change the infusion set just before bedtime unless you can check your blood glucose 1-3 hours after insertion."  I would venture to say that 99 out of 100 times I will shower, change my infusion set and go to bed in that order.  It’s kind of a ritual every 3 days and always at the same time – at night.  I would also guess that many people are not following this guideline.

Medtronic, thank you for the laughs; It’s not often that you put a smile on my face, but this certainly did.

For more information from Medtronic about infusion site management, click here.

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I want to sincerely thank you for your continued support. This blog is better because of you.

Diabetes Humor is a post from: Blogging Diabetes

When I was given a pump, no one ever explained anything in detail to me.  It was basically, insert the infusion set and prime it.  There was never any information about the mysterious disk or any complications to watch out for.  I guess it could be used when going to the beach to keep sand out, but I really don’t know for sure.  I even opened a new box of infusion sets to look at the directions to see if there was any information.  None.  Below you can see what the disk looks like.

Let’s run some rough numbers together:

Remember, I change my site religiously every 3 days and have never once gone to 4 days.  Sometimes I have had to change early, but let’s not take those occurrences into account for this example.

• 4 years x 365 days = 1460 days on a pump
• 1460 days / 3 days per infusion set = 487 infusion sets
• 1 = the number of disks I have actually tried to use

Seriously, I have only used one of these besides giving them to my cats, which makes for some good humor.  Milk top rings and infusion set disks are the best cat toys that aren’t really cat toys.  Not too long ago, Kerri wrote a post that mentioned some situations for using these disks, which were:

• Showering
• In ocean
• Intimate moments

When I have been vacationing, I have never used the disk and haven’t ever had a problem with being in the pools or hot tubs.  I have never worn the disk while in the shower.  Finally, I have never, ever……ever, put one of these disks on before or during an intimate moment(s).  Maybe I’m missing out on a new trend, tip or secret that the doctors never told me about.  Will that disk take things to a different "level"?  I’m actually a little scared to think of the possibilities I’ve been missing out on.  In all seriousness, the only reason I can think of to wear this in the bedroom is so the sheets or clothing doesn’t get stuck on it and rip the site out.

Does anyone have any solid information on the recommended or suggested use for the disks?

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I want to sincerely thank you for your continued support. This blog is better because of you.

Infusion Set Mystery Disk is a post from: Blogging Diabetes

Vanity – When you have a pager-looking like device connected to you 24/7 it can cause some anxiety in certain situations.  Funny aside – the scene from The Hangover where the guy breaks out the pager in Caesars was priceless.  Having the luxury of never dated while having diabetes, this hasn’t been too much of an issue.  However, if I was diagnosed young, you can bet that I may have a complex about my pump.  Ever go to the beach or pool with a pump, it’s a treat.  I even read about someone getting asked not to use a community pool due to diabetes.

Infusion Site Issues – Oh yes… the unknown, “is it my site, could I have a kink, am I getting insulin, is it absorbing” thoughts that swirl when one of those 200+ readings pop up.  Also, you have to deal with gushers [video], bleed backs, infusion sets losing stickiness and sometimes painful insertions.

Doorknobs – If you use a pump, you know exactly what I’m talking about.  For those of you that don’t, I’ll give a try at an explanation.  About 90% of the time I put my pump in my pocket.  The tubing comes out of my pocket, goes up over my waist band and to the infusion site on my abdomen or hip.  When clearing a doorway, the tubing can sometimes get caught on the doorknob and practically rip out the infusion site.  I have never actually torn out the site, but have been “woken up” a few times by a doorknob, which are usually accompanied by a few choice words.  Like it’s really the doorknobs fault…

Scar Tissue – This is an interesting one that I don’t really have a lot of experience with yet.  I can tell that a little scar tissue is forming where I typically put my sites, but it’s only been four years.  What happens when it’s 10, 20, 30 years down the road?  Am I going to be attaching my infusion sets to my neck, armpits and shoulders?  I try to rotate often and not use the exact same site, but it’s difficult to find new places.  You have to imagine a small tube being stuck into you for 2-3 days at a time.  Yes, the area heals after it’s removed, but when you go through about 120 site changes a year, it tends to add up.

Freedom – Showers, pools, hot tubs, locker rooms, gym, beach, sun bathing, rolling around in clean silky sheets, intimate moments, the list goes on and on about reasons it’s sometimes nice to remember what it was like before diabetes and the insulin pump.  I’m reminded of the freedom every three days when I take a shower and don’t have to worry about drying off and getting the towel threads stuck on my site.

Cost – It’s difficult to put a price on excellent diabetes control, but there is a price and it can be hefty.  When I got my pump a few years back, I think I paid a few thousand dollars with my insurance company footing the rest of the bill.  That’s no joke for people that are on a budget.  Not everyone has fat bank accounts with a few grand lying around.  Before pumping insulin, I was on shots for about six years.  I would venture to say that a few thousand dollars would cover the cost of my old syringes for probably 10-15 years.  Then there is the monthly/quarterly cost of infusion sets, reservoirs to load the pump, batteries and site prep supplies that can add up quickly. 

Pump Failure – In four years pump failure has only happened once and it was pretty scary.  Luckily I had [and have] a box of syringes on hand as a backup.  But let’s say I was on vacation or traveling in another country and my pump failed.  I would be eff’d.  Medtronic had a new one to me the very next day, which was about 16 hours from when I called, so it was a non issue at the time.

So that’s my list.  Did I miss any that you would like to add?  If so, drop me a comment and let me know.  Listen, I’m not going to trade my pump in just yet.  I do love it and the benefits, but it’s not all green grass on the other side.  If a nurse, educator, doctor or pump manufacturing rep doesn’t mention some of these issues, they aren’t being honest.  I’m all about honesty and telling it like it really is with diabetes.

What did I miss?

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I want to sincerely thank you for your continued support. This blog is better because of you.

Insulin Pumps – 7 Reasons Not to Get One is a post from: Blogging Diabetes

"Medtronic, Inc. (NYSE:MDT) said today that it has initiated a recall of specific lots of Quick-set® infusion sets that are used with MiniMed Paradigm insulin pumps. An infusion set is a thin plastic tube used to deliver insulin from an insulin pump to a diabetes patient, and is typically replaced by the patient every three days. Affected infusion sets are reference numbers MMT-396, MMT-397, MMT-398 and MMT-399 with lot numbers starting with the number “8.” Medtronic recently discovered that approximately two percent of “Lot 8” Quick-set infusion sets (which represents approximately 60,000 infusion sets out of an estimated 3 million infusion sets currently with customers) may not work properly. The affected infusion sets may not allow the insulin pump to vent air pressure properly. This could potentially result in the device delivering too much or too little insulin and may lead to serious injury or death." (source)

Click here to access Medtronic’s web page regarding the recall with instructions on what to do.  It got a little fuzzy when I tried to figure out how to exchange my sets for new ones.  I called my supplier and they said I should be receiving something from Medtronic or getting a call back from them with further instructions.  It seems that Medtronic is pointing to the suppliers and the supplier is saying they are awaiting more instructions from Medtronic. 

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I want to sincerely thank you for your continued support. This blog is better because of you.

Medtronic MiniMed Paradigm Quick-Set (Infusion Sets) Recall is a post from: Blogging Diabetes

“… My last post was in regards to test strips and the coding procedure that needs to take place. I currently use a OneTouch UltraLink meter.  The reason I am writing is because I found a large variance between when the code is correct between the strip vial and the meter versus when it’s not correct.  Furthermore, I don’t understand the need for coding especially when a wrong code can lead to significantly different results.” [Blogging Diabetes - Tony]

“In regards to your inquiry, as you are aware, if the code number on the meter does not match the code number on the vial of test strips, the test results may be false.

When the strips are manufactured, the membrane is passed through a chemical bath which coats the membrane.  This chemical coating is what causes the test strip to react to your blood sample.  Due to varying degrees of coating on the membrane which cannot be controlled and the biological variances of human blood samples, there is no established percentile difference from one code to the next.  This is why we recommend checking and changing your meter code to match your vial of test strips any time you receive a test strip vial with a different code number than what was used previously.” [LifeScan Customer Service - Jennifer]

I still don’t understand why there are some meters that do not require a code.  Did they figure out something that LifeScan has not?

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I want to sincerely thank you for your continued support. This blog is better because of you.

Why You Must Code Test Strips to Meter [LifeScan] is a post from: Blogging Diabetes

This is a guest post submitted by Lorraine who is doing an excellent job managing her son’s (Caleb) type 1 diabetes.  I met Lorraine through twitter, which is an excellent medium to talk real-life diabetes.  From our first few conversations, I knew that she was doing a lot of things right for Caleb and keeping his A1c numbers near perfect.

I want to thank Lorraine for sharing her story and tips to help manage type 1 diabetes.  Thank you Lorraine and keep up the great work!  Caleb may be too young to understand, but someday he will thank you for all the hard work you put in to help him live a better/longer life.

* * * * *

Managing Caleb’s blood sugar, from a self-admitted neurotic mom

Background:

My son Caleb was diagnosed almost 2 and a half years ago at the age of 3 (almost 4). With so few non-D years behind him, and so many D years in front of him, I have made it my mission to bank as many years as I can with near-normal A1Cs in hopes to minimize those ugly complications when he is older. Caleb has been pumping for just over 2 years, since about 3 months after he was diagnosed. I never set out to achieve a certain A1C.  All I know is I do whatever I can to keep his blood sugars in range.  I am often unsuccessful.  But lots of the time we achieve what we want to. I have never been given any specific guidance on targets or acceptable ranges.  Caleb’s Endocrinologist has always reviewed his results and found them acceptable and not mentioned what precisely they “should” be.

Guiding Principles:

1. I check Caleb’s blood sugar about 12 times a day, including overnight.  Sometimes less, sometimes more.  I check, assess and act.  
2. Everything he eats, I weigh and measure whenever I am able.
3. I do not limit what or how much Caleb eats.  I manage it, but I do not limit it.  There are foods I prefer to stay away from, but I won’t ever tell him he can’t have something because he has diabetes.  Even at school and birthday parties, he eats what the others do.  It usually means 100 plus carbs for a snack and a few extra BG checks, but he smiles as he shoves the cupcake and other junk in his face and that makes me smile.  Everything in moderation – that goes for him and my other, non-D kids.
4. Caleb typically eats 3 meals and 2 snacks a day.  That frequency allows me to be a little aggressive on dosing when I have unknown carb counts.  If I have an uncertainty, I will check and hour and a half after a bolus and if it’s lower than I think it should be, it’s usually around snack time and I can just decrease the bolus of what he eats to mitigate that low without disruption to his schedule.  
5. Caleb seems to go through “waves”.  His insulin needs creep up, up, up….plateau, and then go down, down, down…plateau, and over and over again.  Perhaps all diabetics are like this.  I attribute the waves to growth, but who knows.  In order to keep up with the waves and still keep his sugars in range without constant corrections, I track all his dosing and stats in a spreadsheet.  I used this religiously for months.  As I have learned from it and things have become more predictable, I do not use it as much – only in periods of lots of unexplained BGs.
6. I keep a pretty close pulse on his basal rates.  If there’s a low or high 2 days in a row and I am confident that food is not an issue, I will adjust basal rates.  I know that .05 will have about a 30 point impact on his BG.  
7. Food – Pizza, Ice Cream, Chinese, Bagels, Pasta, anything fried – they all break the rules.  I have charted Caleb’s BG’s for months when he eats these foods and have been able to develop specific extended bolus’ for each.  I keep them in my spreadsheet and in my cell phone.  I continue to tweak them since things are ever-changing, but I at least have a baseline and don’t have to completely freak out when we indulge.
8. Super Bolus.  Of course there are occasions when that nasty 300 pops up.  I don’t mess around.  I find John Walsh’s Super Bolus to be very effective: bolus the calculated correction plus the amount of basal to be delivered for the next two hours.  Then turn off basal for the next two hours.  This front loads the insulin to bring the BG down fast, but prevents bottoming out since the basal is turned off.  This has been particularly useful when we are about to eat a meal that would be awkward to delay (like at a party).  But I am careful with this at nighttime – not quite as aggressive.  For Caleb, I find I need to add a little insulin for those high highs – his normal correction factor needs a turbo charge to tackle those numbers – but of course YDMV.

Those are the highlights.  I’ve been thinking about this as we go through our days to make sure I have everything covered.  I think a big thing is keeping on top of things at night, particularly since that’s about 10 or 11 hours for Caleb.  I check a minimum of two times while he sleeps, but in times of change or when he eats a challenging food, I will check more.  And if a correction is needed, I will always check 2 hours after no matter what.

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One thing that quickly jumps out at me is the care and effort Lorraine puts in to managing Caleb’s diabetes.  She doesn’t just check and react.  There is much more planning, trending and analysis put into his diabetes management than I would expect most diabetics put in, me included.  The theme here is to not be complacent and just wing it.

If you are interested in providing a guest post, please contact me for more information.

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I want to sincerely thank you for your continued support. This blog is better because of you.

8 Tips For A Better A1c is a post from: Blogging Diabetes

Thank you all for contributing and to the winner of the Amazon gift card (watch the video to see who won). 

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I want to sincerely thank you for your continued support. This blog is better because of you.

What Did I Do? [Vlog Answer] is a post from: Blogging Diabetes

What happened?

Who knows, I might just throw an Amazon gift card at a random person who answers correctly.  I will probably post the answer mid next week.

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I want to sincerely thank you for your continued support. This blog is better because of you.

What Did I Do? [Question] is a post from: Blogging Diabetes

In my opinion, A big difference between a type 1 and type 2 diabetic can probably be found in the diet.  Those with type 2 diabetes typically need to control their blood sugar with diet, medication and exercise.  A type 1 diabetic doesn’t need to be as strict because they can just take more insulin.  Even now, I typically eat whatever I want with the exception of pop tarts, candy and very rich desserts.  So, you won’t see me picking up a huge bushel of cotton candy.  However, I eat pasta, pizza, some ice cream, french toast, burgers, fries, etc. without too much consideration for my non-functioning pancreas. 

I can eat basically whatever I want because the insulin lets me.  Do you think a person with type 2 diabetes would eat a whole medium pizza or that delicious dessert from the Capital Grille?  I doubt it.  Yet I can because I simply jack up my insulin to deliver the units to cover the carbs.  Is this smart?  No.

My point here is that taking insulin can give a type 1 diabetic a false sense of comfort and the feeling of normalcy (minus the injections or pump).  Eating a huge brownie covered in chocolate drizzle accompanied by a heaping scoop of ice cream along with 20 units of insulin is a bad strategy to enjoy that sense of normalcy.  I believe that a person with type 1 diabetes should follow a diet that a serious person with type 2 diabetes would.  Taking more insulin to eat whatever you want is dangerous for so many reasons.  I would bet that many people with type 1 diabetes take eating whatever they want to the extreme.  I know this is something I need to work harder on.  Being a diabetic is so much more than just counting carbs and taking insulin.  There’s a whole psychological aspect that isn’t discussed too much in the diabetic community or by the endocrinologists.

Want better blood sugar control and A1c results, cut back on the insulin, cut out the junk food and start exercising.  I’m not saying to eat lettuce for every meal, I’m just saying to seriously consider the amount of insulin you’re taking in to cover the carb intake.  Insulin should be a tool for a healthy life and not a free pass to eat whatever we want. [stepping down off the soapbox]

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I want to sincerely thank you for your continued support. This blog is better because of you.

The Dangers of Insulin is a post from: Blogging Diabetes

1. Basal Delivery – When I was on injections, I would take my dosage of Lantus every night before bedtime.  Lantus is a long lasting insulin that did it’s best to keep my blood sugar down over 20-24 hours.  It was pretty good and I thought it was better than Humalog.  Basal rates on an insulin pump are used to deliver a set amount of insulin each hour and are programmable.  You can set many different rates for different times of the day.  Basal delivery is much more effective and safe than using Lantus or long lasting insulin. 
2. Snacking – I’m not sure what’s going on with my appetite lately, but I tend to snack quite a bit.  If I want a few crackers, that would equate to 1 unit of insulin, BOOM – a few buttons later, I have given myself the insulin needed.  No need to inject a unit or two with a needle.  Historically, I would forego insulin with small snacks because I didn’t want to deal with the hassle of injecting such as small amount.
3. Less Injections – 15 injections versus 1 infusion set.  If you give yourself 5 injections a day for 3 days, that comes to 15 injections.  With a pump, I change my site every 3 days, which only requires one site injection.  You’ll feel less like a pin cushion.
4. Exercise - This could have gone along with #1, but it deserves its own category. The temporary basal rates are excellent for when doing more or less physical activity than usual.  With long lasting insulin, you either need to plan your day the night before or over/under snack to compensate for the difference in activity.  With a pump, you can increase/decrease the basal rate on the fly.  This is a huge benefit that I use all the time.  When I play a round of golf, the temp basal rate comes in very handy.
5. Incognito – The technology is there to have your pump hidden and deliver a bolus (insulin) with a wireless receiver.  Instead of being in a restaurant and having to break out the insulin vial, needle, alcohol, etc., you can push a few buttons and deliver the insulin without much fuss or horrified looks from other patrons. 
6. Analytics - My Medtronic pump connects wirelessly to my computer and uploads data to an online program (CareLink) that I can use to track my blood sugar, carb totals, insulin delivery, average daily insulin delivery, and other analytics.  This is a huge deal, especially for those that don’t want to use manual log books.  Also, the reporting from CareLink is nice to bring to the Endocrinologist to show the daily/hourly trends.

Don’t get me wrong, there are some drawbacks to pumping insulin.  However, the benefits vastly outweigh the negatives when it comes to managing my diabetes.  Also, the American Diabetes Association has their list of advantages/disadvantages of an insulin pump.

What do you think is the biggest advantage to pumping insulin?

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I want to sincerely thank you for your continued support. This blog is better because of you.

Top Insulin Pump Advantages is a post from: Blogging Diabetes

From time to time I will get a series of highs that will drive me crazy.  I review what I ate, how much insulin I took, if my basal rate stopped working or even if my pump battery somehow died without warning me.  To no avail, everything will seem to be right.  A few extra crackers won’t send a blood sugar from 125 to 290 within a few hours.  So what gives, Mr. Diabetes?  When I get a series of unexplained highs or my blood sugar doesn’t come down after one or even two correction boluses, I start to go through my mental checklist.  If you pump insulin, I’m sure you can relate and probably have defined your own system for troubleshooting the highs.

Unexplained Series of High, what I do:

1. First, I review my carb intake vs.insulin taken to ensure there wasn’t a snack consumed while I was “sleep walking” or something.   If everything checks out, then…
2. Take a correction bolus and don’t eat or drink.  If that doesn’t work, then…
3. Take a correction injection and remove the infusion set, then…
4. See if there is a gusher or a fair amount of blood from the site, then…
5. Check the infusion set tubing to see if it looks like it was kinked or damaged, then…
6. Insert a new infusion set at a different site.
7. In the rare instance (happened maybe twice in 10 years) that the next infusion set doesn’t resolve the unexplained highs. I throw away the insulin and get a brand new one from the fridge.  I have had two instances where the only thing I can logically explain is that the insulin was bad.  When this happens be sure to save the vial and report it to your pharmacy.  They have a way of tracking the lot number on the vial to see if others were reported.

[source]

When these unexplained highs happen, it’s so demoralizing.  You try to do everything right like, count carbs, basal rate is “dialed in”, eat right and exercise only to find out the site was bad or the insulin was bad.  Scott, who has type 1 diabetes and writes for Diabetes Daily, said it best:

“We are in this imperfect war, fighting unbalanced battles, sometimes barely winning the fights, and almost always taking a blow to give a blow. It is not easy…” Scott K. Johnson via Six Until Me blog

The title of this post is right; all the trouble with infusion sets isn’t an issue if you are on injections.  You can’t really mess up an injection, unless the insulin is bad.  That said, I wouldn’t trade my pump for injections.

Like what you see?  Subscribe to Blogging Diabetes to stay updated on what’s new with diabetes.

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I want to sincerely thank you for your continued support. This blog is better because of you.

Insulin Pump Disadvantage is a post from: Blogging Diabetes

About 18 months ago, I wanted to try a new location to give the others a “break”.  Logically, I wanted to use a location that I could easily reach and didn’t involve a crease in my skin when sitting.  Some areas around my abs tend to crease when I sit; so the set will become irritated or lose its stickiness.  Where did I end up? The top of my thigh.

[source] – not an actual representation

I am not really overweight, but could lose maybe 10 pounds.  I was always playing soccer, lifting weights or running growing up and developed very strong leg and quad muscles.  But I thought, what the heck, why not try a new location.  What’s the worse that could happen?  Famous last words, right?

I used the quick set tool to set the location on the top of my thigh.  What came next was intense pain.  I’ve never, ever, had a site go this terribly wrong.  I couldn’t move my leg without the pain shooting up my body.  So I very calmly started FREAKING out.  Another tid bit of information is I don’t typically shave my legs (hey, it was winter), which contain a bit of hair.  In hindsight, there wasn’t a whole lot of logic or thought put into the removal part. 

I hate to scare people because some insulin pumpers may use their thighs all the time with no problems.  It really just depends on the person and their body type.  I basically had to rip the infusion set out, which started the river of red down my leg.  I applied pressure until the blood stopped and said to myself, that was a bad f’n idea.  After that day I have never ventured below my hips for an infusion set, ever.

Maybe I’ll try my upper chest next time.  At least the infusion set will look like an electrode for an EKG machine.  That might be a good summer look and chalk up a few weird looks…

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I want to sincerely thank you for your continued support. This blog is better because of you.

Insulin Pump Infusion Set Location is a post from: Blogging Diabetes

This is the second post where I am attempting to be honest and give some real-life insight where a doctor probably wouldn’t.  The first post, discussed the sporadic jump in my blood sugars for no apparent reason.  This video will tell you about something that happens every so often when changing an infusion set. 

I am not trying to scare you with this post; just trying to tell it like it is in the real world of living with type 1 diabetes. 

If you’re an insulin pumper, you will probably have an incident like this, if you haven’t already – it’s just a matter of time.  When it does happen, be calm, know that you aren’t alone and to apply pressure for a few minutes.

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I want to sincerely thank you for your continued support. This blog is better because of you.

What The Doctor Won’t Tell You – Part 2 Gushers is a post from: Blogging Diabetes

As you can tell from the video, I roll with the New England Patriots.  And, no I’m not a bandwagon fan either.  I grew up in the Western part of Massachusetts and then lived about five miles from Foxboro, MA (where their stadium is) for about 5 years.  I’m also a huge Red Sox and Celtics fan, which has been a very good thing of late.

I hope you like the video!

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I want to sincerely thank you for your continued support. This blog is better because of you.

Medtronic Minimed Insulin Pump – Death Code is a post from: Blogging Diabetes

It actually created more stress on me because I was constantly worrying about if the glue was going to give and expose the site.  Also, the movement on the site caused it to become irritated and itchy.  In the end, I prematurely changed the site location just for peace of mind and risk of infection.

Next time, I will check my crease before choosing a location.

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I want to sincerely thank you for your continued support. This blog is better because of you.

Infusion Set Location – Tip is a post from: Blogging Diabetes

6 Insulin Pump Tips

1. Battery – I first got really annoyed when my Costco Duracell batteries lasted a few days, at most, in my pump.  I didn’t like feeling like I could run out of power and be helpless every few days or even every week.  I then switched to Lithium batteries (I think they are marketed for digital cameras) for my pump and have never looked back.  These batteries last probably around a month and a half before I change them.  Yes, they are pricey at about $9 for a 4-pack, but are well worth the price and peace of mind.
2. Clean – In the three years I have been using my pump, I have yet to get a site infected (knock on wood).  I seem to think it’s because of my paranoia about the site’s cleanliness before attaching a new infusion set.  About 95% of the time, I shower so my skin is soft and clean when changing my site.  I also use IV Prep pads and let it dry before attaching the infusion set.  I have never used any other glue-type substance when attaching my infusion set.
3. Changing the Site – I am religious about never going more than 3 days on one site location.  I think this also helps to reduce scar tissue and the possibility for infection.  Also, thank goodness for the quick-setter because doing it manually just makes me cringe.
4. Location, location, location – I am trying to find new site areas for my infusion sets because I don’t want to build up too much scar tissue and like to give an area a break every so often.  I start on my left outside abdomen (love handle area) and work clock-wise to my left lower hip (just below my pant line).  Next, I go to my right lower hip and finally end on my right outside abdomen before starting the cycle over again.  I don’t use my arms, legs or butt.  I have a funny (not funny at the time) story that I will share regarding site location in an upcoming post.
5. Pool or Beach Day – This tip is strictly for the men or women that wear board shorts bathing suit bottoms.  I have a few pairs of board shorts that have a velcro pocket on both sides.  When I know I am going to the pool or beach, typically on vacation, I will use my lower hip area for my infusion site location.  I do this because it is hidden from view except for the small tube to my pump, which is nicely located in my pocket.  I never wear my pump in the water, so it’s also easy to disconnect and remove.  Maybe I am alone in not wearing it in the water, but I just am too afraid to get it ruined when I’m on vacation and be stuck.
6. Settings – Work with your doctor to fully utilize your pump.  You can set a few different basal rates for different times of the day where you may need more or less insulin.  Also, get a meter that communicates with your pump wirelessly.  Often I forget what my glucose level was from my last reading for using a meal bolus.  If you are using the bolus wizard shortly after testing your glucose, it will already have your glucose level stored in memory.  I’m not sure if this functionality is just for MiniMed pumps or others as well.

What other tips have you learned or heard about for using an insulin pump?

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I want to sincerely thank you for your continued support. This blog is better because of you.

Top 6 Insulin Pump Tips is a post from: Blogging Diabetes