Interview with the ID Band Company

It's always refreshing when a company with a vested interest in a medical condition want to learn a little more about the people wearing their condition every day.  So when the ID Band Company got in touch saying they wanted to do a series of interviews with people with diabetes, it seemed like a great opportunity to say my bit.

Hannah Keane, on behalf of the ID Band Company Blog got in touch and put together a piece about living with type 1 from my perspective, and what was even more refreshing than having someone without type 1 asking questions using 'our' version of English (full of words like 'pumps', 'carbs' and 'individual'), was that they seemed to 'get it' when asking questions about diabetes.

We spoke about my initial struggles accepting diabetes, and about finding balance and respite in the diabetes community.

So check out the interview here, and enjoy their blog posts.  I certainly am! 

Cellnovo: Here at last!

For a number of years there was a greatly anticipated buzz in the Diabetes Community about the Cellnovo patch pump. With its sexy slim design and iPhone-like handset, along with the fact that the tubing could be extended if you really wanted it longer or be kept in patch-pump style, it was a greatly anticipated addition to the growing arsenal of diabetes tools.  

But when things went quiet after the device received CE marking in the UK, fears started growing that perhaps all was not well in Cellnovo-land.  That was, until INPUT added a certain photo to their Facebook page all the way from the Advanced Technologies and Treatments for Diabetes (ATTD) in Vienna in February 2014.

It seems that if you are in 'selected centres' in the UK, this pump is back in town!

There is only a little information out there at the moment so keep your eyes peeled on Insulin Independent's pages for updates!

Medtronic Enlite: The Next Generation sensor and grab-it-white-you-can offer !

When Medtronic released their new, much-improved Enlite sensor they certainly stepped up their game in the UK Continuous Glucose Monitoring (CGM) market.  Thinner, more accurate and boasting a much more user-friendly inserter (for those who remember the early Sofsensor 'harpoon'.  See also 'yowzer'), it made waves.  So far over 6000 of you have clicked on that post wanting to know more.  And the great news for 2014 is that Medtronic are launching an upgrade!

The new 'Next Generation' sensor will start going out to users automatically as from Monday and you'll be able to tell if you have a box as they will have a shiny yellow sticker saying 'New'. And who doesn't love something new?!

The new sensors will benefit from:

• Increased comfort with the implanted volume of the sensor being reduced by 80%
• Sensor adhesive has been improved to reduce skin irritation issues
• More consistent performance
• Reduced likelihood of data gaps

And they now sell in single units, too.

Now if you've been thinking about CGM, perhaps because you have a Veo pump with CGM integration on stand-by, or perhaps are due for renewal and the Veo has caught your eye, you may want to have a look at Medtronic's get-you-started CGM offer.

The deal they are offering until 30th April this year, is that when you buy 1 box of New Generation Enlite sensors (5 in a box) you will get the MiniLink Transmitter for free (usually setting you back £490).  And to sweeten the deal even further, when you order you're 4th box of sensors, that box is free!  

So if you've been looking at CGM and strongly considering making it part of your self-management system, perhaps now is a good time to try it out.  After all, if you're only paying out for the sensors you would have used anyway, what have you got to lose?  

Medtronic are very keen to chat to anyone who wants to try their CGM, so get in touch to arrange contact with a rep either by phone (01923 205 167) or if you are more of an email it kind of person, contact believeinbettercontrol.uk@medtronic.com

And as a CGM loving Dexcommer, I'd love to know how you get on!

Paraphernalia free.

Wearing an insulin pump and Continuous Glucose Monitor (CGM), irrespective of how life-changing and valuable they have become to me, does come with its drawbacks: the paraphernalia, for example. 

The insulin pump is a fashion faux-pas whose clunky outline forever graces my profile. It either sits on my waistline likening me to an 80s yuppie with my pager in tow (anyone under 25, look it up), or it nestles between the 'twins', occasionally protruding and distorting the shape of my chesticle area. Much to the horror of unsuspecting onlookers. 

My CGM sensor usually graces my upper arm and although a great deal smaller, is perhaps even more obvious because upper arms aren't normally fitted with their own on/off switch. Mine is, however.

Cannulas changes happen every two days (the drawback of steel over Teflon). And CGM sensors last between two and three weeks. So paraphernalia-free baths are few and far between. I imagine planets align on a more frequent basis. But now and then, the ducks line up. 

You very quickly learn to wash paraphernalia areas with a certain caution, because a knocked-out £50 CGM sensor ruins even the most sunny day, and a pulled out cannula is no picnic. So a day when all landscape is free and clear is a treat not oft-enjoyed, but deeply treasured.

This afternoon as my 18-day CGM sensor expired and my set-change alarm piped up on my phone, I knew what delights would lie in store for me tonight. The water heater is primed to stay on that edge hour for that slightly deeper bath, and my bath bomb has been retrieved from the back of the cabinet. 

Between 8 and 9pm tonight, the door will go unanswered. 

Do you treasure the paraphernalia-free moments? 

Complacency: winging the cannula change.

Dexcom site change day.  

Prescription order day. 

Prescription collection day. 

Sensor order day.  

Pump supplies order day.

Insulin reservoir refill day.

Cannula change day.

Keeping on top of diabetes self-care must-dos can be a challenge. None of the jobs above ever seem to fall on the same day, for me, anyway.  Sometimes they are days apart; sometimes they take a few days to organise; sometimes they fall on the same day.  On more than a few occasions I've put in a (way too) late Friday night order at 4:59pm to my diabetes team for supplies, knowing that Monday will be a race to the (clinic) finish line, kind of morning.

Over the years I've used a host of methods to try and make sure I don't use cannulas longer than I should. I've used iPhone alarms, always changing on certain days (clearly whomever invented weeks didn't have to change cannulas every three days....) and the old favourite, 'winging it'.  Since switching to steel cannulas (which are two-day wear, rather than the three-day Teflon alternatives) I've been pretty good at remembering to change them.   Of course now and then, I may let things slip.

Since 10am this morning I've felt a little as though I've been fighting to keep the blood sugars in their usual fairly happy morning state.  The temporary basal have had to creep up on an almost hourly basis to blunt the effect of somethingorother affecting them.  My overestimated 2-unit dose for a 1-unit bowl of fruit didn't even blunt the sides.  I may as well not have taken any insulin. And my 13.7 and rising hardly reflected the 20g fish and stir-fried vegetable dinner.

"But I changed it on Wednesday evening!  It's only Fri.... Oh."

By day three my cannula is usually the biggest reminder that I've by-passed change day.  Of course, I shouldn't be waiting until day three, and had I been a little more organised I'd have switched it out last night.  But what do you know, 40 minutes post-change and the 3rd or 4th correction of the day finally budged me back in the direction of the black.

Do you struggle to make your diabetic routine match up?

CGM: Clinging on

At £50 a pop (for a week's use sensor) Continuous Glucose Monitoring is an expensive habit.  But being one which improves my control, gives me a Safetynet to tell me when my sugars are dropping, rising or stable, and moreover gives me a sense of empowerment and superwoman-style 'I have the power' confidence, I have deemed it worth it.  

So the last thing you might want to do with a brand new sensor is have a vigorous shower (?) and knock the sensor.  Why might you not want to do this?  Well, my (apparently very) aggressive showering style meant that on day 2 (F*$@!) of my new sensor life, I found myself facing a rather disabled looking sensor.  Hanging by a thread and only still clinging on for dear life by a small section of tape and the sensor itself, the days appeared numbered.

In the hope I might be able to squeeze even one week out of this one, accepting that I might have to deal with my first less-than-seven-day sensor in a year of CGMing, reminding myself of all the 20-something dayers, I slapped on a Kinesiotape in my very best patch-up attempt

But much to my joy and delight, with a further layer of Tegaderm to keep out the damp and add another layer of sticky, this little bad boy has made 9 days and is still going strong!  Dexcom sensors never fail to impress me; with its accuracy; with its bomb-proofness (bom-proofability?!); with its robustness.  And this one has failed me not.

I'm not sure how much longer I will be able to squeeze out of this one but here's hoping!

#betesonabudget

Off-label CGM use: words of caution from my consultant

I spent most of today thinking my 24 day-old sensor was 'way off', because the calibrations were rarely within 1 mmol; something I have come to expect from my trusty companion.  When I wasn't scoffing at the result, I was resigning myself to pulling it - something I hate doing when I've managed to get almost a month out of it.  For some reason I become attached to a sensor the longer it lasts and the better it performs.  But I thought that this might be a good opportunity to test out a word of caution my consultant had given me in clinic some months ago.

When my consultant found out that I was using my Dexcom G4 sensors for waaaaaay longer than the 7 days they have CE approval for, he offered me a word of caution.  Two, in fact.  Firstly, doc was worried about the damage I might be causing to my might-be-needed-one-day cannula sites, as I was regularly getting 21-28 days out of sensors - up to four times longer than advised.  The second concern he had was that over time, the peaks and troughs the trace would show me would be less sharp as the sensors response to glucose in the body becomes blunted, meaning you won't get the precision you are looking for and could even miss the highs or lows you bought CGM to catch in the first place

As I downloaded the data I was writing the 'watch out for this, folks' post in my head already. But as I looked at the picture, this is what I found:

The red dots are my blood glucose calibrations today, while the purple trace is the results my sensor was providing.  I felt surprise as I looked at it, having been convinced this was 'the risky bit' my consultant had warned me of.  But even though the calibrations felt 'way off', when you look at it though the objective eyes of hindsight (and some kick-ass software), the valuable trend information (that we have so banged into us is more important that the 'exact number') is still there.  At my highest point the sensor was spot on, and at my lowest it was still reflecting the changes in my glucose trends.  In fact when you really look at it, the CGM still appeared to be picking up a few more peaks and troughs than my BGs did, as it should.

Perhaps it felt that way because this is the kind of data you see would normally see on day 5 of week 1, when the sensor has had a chance to be calibrated numerous times but is still a 'fresh' sensor, in the long run:

This day was generally filed under 'not so great'.  Any BG of 18mmol at 3am is always filed under 'not so great' (unless you are normally 24mmol at that time of night, in which case, go you!), but despite the crazy roller-coaster day, the only two calibrations I did (unusual, for me) were both absolutely spot on.  Perhaps it is because of this kind of precision that I have become so accustomed to that threw me off when the calibrations seemed so 'far off' today. 

But having seen the data from today and realised that the sensor was not as AWOL as I felt it was, I'm going to keep hanging on.  Despite being 24 days in I've yet to see more than one set of ??? marks, meaning communication-wise the sensor is still going strong and speaking to the received without any problems - something that can falter in an older sensor.  And although my calibrations are a little off bulls-eye, the trend data is still more valuable than finger sticks alone, so I will plough on until this one gives up the ghost for good.

Hopefully sometime in 2015.