6 things for 6 years

9 11 2010

Happy D-blog Day!

To celebrate the 6th annual d-blog day, here are 6 things I think people should know about diabetes.

  1. Yes I can eat that! With the advent of insulin pumps and CGMS, there is no real reason I can’t eat whatever I want.  Not to mention that sugar-free stuff just plan tastes nasty.  If I’m going to eat the carbs anyway, it might as well be something delicious.
  2. Taking insulin is not “bad”. I do not have it “really bad” because I have to take insulin. My body simply doesn’t make insulin anymore, so I need to replace it manually.
  3. I’ve got it, but sometimes I need help. Most of the time, I am super aware of all the intricacies of what’s going on in diabetes-land.  I know that my blood sugar is going up, but it’s okay because I just ate and I know I bolused accurately, etc.  Or that I may be dropping, but that’s good because I was high before.  However! Sometimes I am low and I don’t know why and I need someone to cut me some slack and get me some Starburst.
  4. My CGMS is amazing. This thing catches everything.  It tells me when I’m high; it tells me when I’m low; it tells me when I’m going up or down too fast; it will remind me later if things haven’t improved.  Because of this device, I have kept my A1c at 6.2% or lower (below 6.0% is NORMAL) for 2 years.
  5. Diabetes is expensive. 4 endo visits, regular doctor, OB/GYN, eye doctor, dentist.  6 test strips per day x 365 days = over 2000 strips per year.  New infusion site, pump cartridge, and tubing every 3 days.  A CGMS sensor is $135 before insurance, which is only supposed to last 7 days.  The pump itself is over $6000.  I just started with new insurance, and next year I will EASILY hit the out of pocket maximum of $2500.  Probably by May.
  6. The D-OC is awesome. George, Kerri, Scott, Bernard, LeeAnn, and Allison are all household names.  You are all my friends.  And not qualified with “diabetes online friends”.  Just “friends”.  ❤




Oh, insurance… What are you doing?

10 11 2009

I got a letter yesterday from my health insurance stating that they are no longer covering my Dexcom sensors, starting from August. I was confused because they’ve covered them in the past. Based on the code they listed, I assumed I had hit my DME cap for the year (this was my first full year on the sensors) and would need to appeal.

However, after spending 1 hour talking to 5 reps, I found out that the health insurance has randomly decided they are “disposable” since I throw them out after 7 days and they don’t cover “disposables”.  I imagine that “disposables” is intended to cover things like alcohol wipes and cotton balls, which they should rightly not cover.  However, 7 days is hardly “disposable”.

Edgepark (the company that provides the sensors) is already working it and their argument is that they’re not considered “disposable” since they are used in conjunction with a Durable Medical Equipment (the receiver).

I won’t know anything for at least 5 business days, but it is good to know that Edgepark is trying to regain my coverage.  I really cannot afford to either a) pay full price for the sensors or b) limit my use of them to every other week or similar.  I just hope this gets straightened out.





Data and what to make of it

2 11 2009

I just downloaded data from my Dexcom and have been taking a look at it.  There’s so much data and so many different ways of looking at it; it’s hard to tell what to make of it.  There are a few items I like to focus on:

Modal Day screen

  • average blood sugar for the month
  • average blood sugar for the past 3 months
  • standard deviation

Glucose Distribution screen

  • % in range for the month
  • % in range for the past 3 months

Success Report screen

  • compare data montly
  • compare data quarterly

The average will tell me about what my A1c will be.  I use this chart and I have found that comparing my Dexcom average to this chart is very close to my actual A1c.

The standard deviation will tell me if I am doing too much of a rollercoaster.  Lower is better.  I will confess, mine is not as low as I would like, so I know that I need to level it out.

% in range is very important to me.  Knowing that I am in range 75% of the time is greatly empowering.  Knowing that I am 95% in range upon waking is even more empowering.  Of course, knowing I am only 50ish% in range after lunch tells me that I need to work on that area.

Comparing the data from month to month is great for trends.  I can see that my average in October was less that what it was in September, which is great.  I can also see that my average for the last quarter is lower than the previous quarter, so I imagine that my A1c will be lower as well.

Using the Dexcom software can be a little overwhelming (there’s so much more data available than I even mentioned), but if I focus on these few things, I feel like I have a pretty good handle on my diabetes control.





Another trick up my sleeve

7 10 2009

I’ve been using the super correct method to get my blood sugars down.  I have updated my technique to make it work a little better.

1.  I did end up doing the super part as “fill cannula”, which does annoy me that it doesn’t get tracked anywhere.  However, I imagine newer pumps will have this feature built in.

2.  I do the fill cannula in 2 steps, per Bernard, so that the last number listed is the correct “fill cannula” amount.  This prevents any weird things happening when I change my infusion site.

However, the newest trick added to the arsenal is using a temp rate to combat a low without having to eat Starburst.  =D

This mostly works because I have a Dexcom and can see these things coming.  If I am just above target, but going down too fast or have too much IOB, I will set a 10-15% temp rate for half an hour.  This small drop in insulin is enough to get me to my target and stay there, instead of dropping below and having to eat something to bring it up.

Just one more thing to add to my arsenal.  Take that, diabetes!





IV-3000 SUCKS!

2 11 2008

I am having a pretty good time with the Dexcom sensors, but I can only get 7 days out of them before the adhesive peels off and I have to get rid of it.  I was looking for a way to increase the life of my sensors, so I bought some IV-3000.

I figured that if I put the IV-3000 down first (cutting a hole in it for the needle of course), then that would stick to my skin, then the sensor would stick to the IV-3000 and it wouldn’t peel off.  We had our first trial run today and it sucks monkey balls.

Not long after I put the IV-3000 down, I already saw it peeling off near the edges.  Then I took a shower and all hell broke loose.  The whole sides were coming off and I had to stick it down with some heavy duty medical tape (which I loathe to use because it’s really stiff) so I didn’t lose the sensor.

What went wrong?!?!?  I read all the instructions and I couldn’t really tell if it was something I did.  Am I not supposed to use IV Prep wipes in conjuction with the IV-3000?  Am I not supposed to get it soapy?  It says it’s waterproof, but that does not seem to be the case.  I thought this IV-3000 was the best adhesive money could buy, and now I feel duped.  What a waste of $50.





Cutting it awfully close

29 09 2008

I had a system set up for reordering my sensors.  When I put in a new sensor and I only had one spare for backup, that’s when I would call EdgePark to reorder.  That way, I would still have a backup and new ones would arrive before I had to tap in to my last sensor.

Things do not always go as planned.

I called to order and then didn’t hear anything for a couple days.  The nice CSR told me that they were waiting on a Rx from my endo.  Um, what?!?!?  Turns out that Dexcom “changed their packaging” or something and they needed an updated letter of medical necessity.  I instantly paled at the thought that my sensors would no longer be covered and I’d have to jump through a million hoops to get them back.

It took an awfully long time to contact my endo (they don’t have a number that goes straight to a person, only a line where you can leave a message) to know if they faxed the form.  Then an awfully long time to get confirmation from EdgePark that they were sending my sensor.  They were able to ship one box, then it looks like I will get a 90 day supply after that.

I stretched my penultimate sensor as long as it would go, but I eventually had to switch to my very last one.  I have been extra careful with it to make sure it lasts until my new sensors arrive.  I finally got the tracking information today and the new sensors arrive tomorrow.  Today was day 7 with my last sensor, so they are cutting it awfully close…





Things I would like to see

30 07 2008

As I use all this diabetes technology, I can see a number of things that I think need improvement.

Dexcom

  • A secondary high alert.  I see 2 options with this:
  1. One alarm could be set at 160, then another one at 220 (just for example).  So you would get notified when you went high, then notified again if you went really high.
  2. One alarm set at 160 (for example).  But then, if you stayed above 160 for an extended period (user-configurable), it would notify you again.
  • Different ranges for day/night.  I hung out at 130 all night last night.  This isn’t high enough to trigger my high alert, but it’s not really acceptable for overnight.  I could manually set my ranges before I go to bed and when I wake up, but that’s a waste of time.

Cozmo

  • Super bolus option.  I am currently doing a workaround which involves taking the basal-as-bolus via the “fill cannula” method.  As far as I can tell, the insulin given that way is not calculated anywhere in my daily totals.  Given that they can do combo boluses, super boluses aren’t really that different.

I would think that these things could be easily implemented with some software updates.  They’re small changes, but would make a big impact on my overall quality of life.  Got any other ideas?