t:slim™ Insulin Pump

I am eagerly awaiting the release of a new insulin pump, the t:slim™ by Tandem Diabetes Care.  On November 16, the FDA granted the Company the clearance to market this new pump.  Some of it's marketable features are the fact that it is 25% smaller than other pumps (like the One Touch Ping I use.)  It is about the size of a credit card and as thin as a smart phone.  Another cool feature?  A color touch screen.  

Just today, Dexcom (the company that manufactures my continuous glucose monitor) announced that it has "entered into a Development and Commercialization Agreement with Tandem Diabetes Care, Inc. to integrate DexCom’s next generation continuous glucose monitoring (CGM) system with Tandem’s t:slim™."  How awesome!  Hopefully that means that the t:slim™ and the Dexcom will be integrated into one device...

I just got my One Touch Ping in March, so it almost a year old.  Pumps have a four year warranty on them, so insurance will cover a new one every four years.  So, I have about 3 years to wait until I can get a new pump.  By then, the t:slim™ should be ready!

Vacation...from my Dexcom

Recently, we took a 9-day vacation to Florida.  We spent some time in Tampa and at Disney World and we had a great time!  Three days before we were supposed to leave, I went to get another set for my Dexcom CGM.  That was when I realized that I didn't have any left, and I was wearing my last one.  Yes, I know, not very smart.  I guess the week before when I had grabbed a set, I didn't realize it was the last, and didn't pay attention.  So...there was no way I was going to be able to place an order for more in time to get them before we left on vacation.  Now what?

I got a little freaked out.  The CGM sets are "good" for a week.  Meaning that my Dexcom will tell me when it is time to change the set, and you have to stop the sensor, put a new set in, and start the sensor again.  If you don't do that process, the CGM will shut itself down and it won't register your blood sugar.  (Since I have gotten back from vacation, I have started to "trick" my Dexcom, meaning that you stop the sensor, keep the old set in and start the sensor again.  The machine really doesn't know that you didn't put a new set in, since it was stopped and started again.  I am sure the manufacturer doesn't recommend this, but it is a way to save some money on sets, and I have found than many Dexcom users do it!  BUT, before we left on vacation, I hadn't begun doing this trick thing yet.)  I figured that I wanted to be wearing my Dexcom for sure on the days we were at Disney because I knew I would be doing more physical activity and probably not eating at normal times.  So I took off my sensor the day I was supposed to change it, and was going to wait to put it back on the day before we went to Disney.  In my head I had it all figured out!!!  I was being responsible!!!  It would be fine!!!  I packed my precious last set and my Dexcom in my suitcase and we were off on our first days of vacation.

Fast forward a couple of days, and I am getting things in order to leave from Tampa to go to Orlando.  I am packing up and organizing mine and all of the boys stuff that we would need for our four days at Disney.  I am making sure I have all of my diabetic stuff in a backpack that we will be carrying in the parks.  I get my last set and Dexcom out and I am ready to put the set in when it dawns on me that I LEFT MY SENSOR AT HOME IN MICHIGAN!  Yes, the sensor, the part that feeds all of the information from the wire that goes into my skin to the Dexcom machine, where I can then see the information on the screen.  The part that makes the whole system work.  The part that, without it, I can't use my Dexcom!!!  UGH!  I was so upset with myself.  A rookie error!

Needless to say, I survived the trip without my Dexcom.  I just had to check my blood sugar more often and pay attention to how my body was feeling.  For a person with some hypoglycemic unawareness, it was kind of hard.  I got done riding Space Mountain two times in a row and felt light-headed.  I thought it was just because of the ride, and the lights flashing.  We got in line to get pictures with Phinneas and Ferb and after about 5 minutes of just not feeling "right" I told Matt I need to check my blood sugar.  It was like 54.  He got me a juice bag and some peanut butter crackers out of the well-stocked backpack and I was fine a few minutes later.  It was strange to have the safety net of my Dexcom gone.  When I have it with me, I don't have to think so much about my diabetes.

We weren't back in Michigan for more than an hour before I put in my last set and started up the sensor.   It was good to have it back!  As annoying as it can be with all of the beeps, and as much as it makes me crabby when it wakes me up in the middle of the night (and I have to leave my warm bed to get a glass of OJ) I am very thankful I have it.

Hi Ho, Hi Ho, It's Off to Work I Go!

Tuesday it was back to school for the kids and back to work for me!  I am not sure if my boys were all ready, but I sure was.

I have been home all summer, which means my diabetic supplies were always around me.  Now going back to work I have to make sure to cart it all along with me...OR make sure to keep some of them at work.

Supplies Needed:
Insulin Pump (sad to say, I have left it home before.  Good thing I only live a few blocks from work.)
Glucose Monitor
Bottle of Insulin
Extra Reservoirs
Continuous Glucose Monitor
Extra Glucose Monitor Set
Extra Test Strips
Extra Infusion Set
Ketone Testing Strips
Capri Sun/glucose tablets
Peanut butter crackers/other snack

If you see me walking into Zion with my rolling suitcase, you'll know why!

High Blood Sugar and DKA

I have talked a few times about low blood sugar, so now I will go to the opposite end of the spectrum and talk about high blood sugar.

For me, High Blood Glucose (Hyperglycemia) can happen because I haven't taken enough insulin, I am stressed out or sick.  The main symptoms are increased thirst and frequent urination, but when my blood sugar is high I also can get lethargic and/or crabby.

Hyperglycemia happens to all diabetics at some time.  This is normal.  The problems occur when your blood sugar is high continuously.  Hyperglycemia can bring on a very dangerous problem called Diabetic Ketoacidosis (DKA.)  DKA occurs when the blood sugar is high because of an insulin deficiency (which makes sense, because without insulin a diabetic has no way to bring their blood sugar down.)  Rather than trying to explain it myself, here is a definition from mayoclinic.com:

"Sugar is a main source of energy for the cells that make up your muscles and other tissues. Normally, sugar enters your cells with the help of insulin. If you don't have enough insulin in your body, your body won't be able to use sugar for energy. This prompts the release of hormones that break down fat as an alternate fuel. In turn, this process produces toxic acids known as ketones. Excess ketones accumulate in the blood and eventually "spill over" into the urine."

Symptoms of DKA include:  frequent urination, excessive thirst, vomiting, dry mouth, confusion, increased heart rate and rate of breathing, and the most distinctive, a fruity odor on the breath.  DKA can be confirmed at home by taking a simple urine test using a urine test strip.  Spilling ketones into your urine is serious and you should contact your doctor if this happens.  Normally, if you are able to bring your glucose level down to normal, you will stop spilling ketones.  However, this is sometimes more easily said than done, especially if you are ill for a few days in a row.  If left untreated, DKA can be fatal.

Complications of long term hyerglycemia include:  blindness, amputations due to nerve damage, heart disease and kidney disease.

Ugh.

Matt Saves the Day!

Last night Matt and I went to our neighbors house, sat on their porch and had some drinks.  We got home at about 11:30.  I knew my sugar was running high (from my Dexcom) so I tested and needed to take 3.75 units of insulin.  I only took 1.75 units because alcohol tends to make my sugar go lower.

I woke up at 1:30 to my Dexcom BEEP BEEP BEEPING at me, I grabbed it and looked at the screen and it said that I was low (under 70 mg/dL.)  I got up out of bed, mad, tired and just plain irritated.  Came downstairs and remember we didn't have any orange juice or Capri Sun left in the fridge (which is just plain dumb of us) so I opened the cupboard to grab my glucose tablets and remembered that I had left them in my van (I had gone to Zumba in the morning and had taken them along with me.)  So now I am really crabby, grab my keys, go out to the van, get my tablets and sit down at our island and start crunching them.

Meanwhile my hubby had gotten up and was going through the cupboards looking for something to give me.  He was asking if a sandwich would help, or a cookie.  I kept saying "NO!!!" and yelled at him more than once (low sugar talking.)  He stopped and looked at me and said, "Stop yelling at me!"  I had taken 4-5 tablets and started in on eating some peanut butter crackers (rule of thumb for treating a hypo: fast acting sugar, followed by carb + protein) and all of a sudden I can feel this wave coming over me.

I am starting to sweat.  It started with my forehead, then my arms, then I could feel it dripping down my chest.  I looked at Matt and told him, "I need something, these tablets aren't working fast enough!"  Now the back of my neck is sweating and I can feel my hair getting wet.  He looks at me, takes the keys and drives 2 blocks to a local bar to grab some pops.  He was gone for 5 minutes at the most.  By the time he got back, my shirt was completely drenched, my hair was drenched, my shorts around my waistband were soaked, and I had sweat dripping off of me onto the island.  I had my head in my hands and I just wanted to lay my head down and sleep.  He walked in and gave me a Pepsi, I couldn't even open it, he opened it and I slugged 1/2 of it down.  Within seconds I could feel the difference.  The sweating let up. My head started to clear.

It is amazing how fast it came on.  Thank goodness my Dexcom woke me up!  I took another swallow of pop, then we turned out the lights and went back upstairs.  And, I thanked Matt for getting the pop, and apologized for yelling at him.  Told him I didn't really mean it.  Luckily, he understands and doesn't take it personally.

My Buddy Chase

Today Chase and his brother Nolan came over to our house to spend the day.  Like me, Chase has T1 diabetes.  He is 6 years old and was diagnosed at age 3.  He also has a One Touch Ping insulin pump and glucose meter.  This kid is amazing!  He tests his sugar and does his own boluses all without complaining.  The kids all wanted to have a Flavor Ice, and since I did not have the original box I wasn't sure how many carbs there were in one popsicle.  I hopped on Google and found out one Flavor Ice has 6 grams of carbohydrates.  I told Chase he could have one because I figured out how many carbs it has and he said, "It has 6!"  DUH.  I should have just asked him to begin with!  Being around Chase today made me see (again) that you just have to move on and deal with it.  Yes, we have diabetes.  Yes, it is hard work.  Yes, it stinks.  However, we can see, hear, walk, talk and think.  It won't stop us from living a good life, having fun and being happy!!!

Here we are with our matching pumps:

 

Hooray for One Touch Pings!

CGM: Continuous Glucose Monitor

In May, I got a CGM (Continuous Glucose Monitor.)  It keeps track of my glucose level 24/7.  I use a Dexcom Seven Plus.  It consists of 3 parts:  sensor, transmitter and receiver.

The sensor is a small, round, flexible wire about the size of 2 human hairs.  It is inserted under my skin by a small needle into my stomach or love handles, and looks like this (the small wire sticking up in the air:)

The transmitter is like a mini computer.  It sends all of my glucose information to the receiver.  The transmitter snaps into the sensor and then adheres to my skin.  It looks like this:

    
The receiver is what collects and displays my glucose information.  It is about the size of a cell phone and I usually keep it in a pocket, purse or sitting next to me.  It needs to be within 5 feet of the sensor in order for it to work or else an "Out of Range" error message will display on the screen and it BEEP BEEP BEEPS!!!  It looks like this:

The CGM has been wonderful for me!  As I mentioned in my last entry about hypoglycemia, I have hypoglycemic unawareness.  This means I do not get symptoms when my sugar is getting low.  I have had 4 serious hypoglycemic events  in my years with diabetes.

The first was 4 years ago.  I was supposed to go to a wedding shower out of town, so my Mother-in-Law was coming over to pick up 2 of my children for baseball.  She came in and asked the boys where I was and they told her I was still in bed.  She came upstairs and said that she could smell my sweat (The Sweat Fairy visited!!!) before she even came into my room.  I was incoherent (and don't remember anything...) but with some help from Matt's Grandma they were able to get me to drink some orange juice and I came around.

The second was about 3 1/2 years ago.  Again, it happened in the early morning hours.  My husband ended up calling home and my oldest son answered the phone, and told him I was still in bed.  My son brought the phone upstairs and my husband could tell by my speech (slurred, almost like someone that is drunk) that I was low and he called my neighbors who are EMT's and they came over and were able to give me glucose gel and I came around.  Of course, the sweat fairy had visited again!

The third time was almost 3 years ago.  I remember it was a Friday.  I got up and got busy around the house and didn't eat breakfast or lunch.  The last thing I remembered was that Days of our Lives finished (2:00) and then when I woke up I was in the ER.  Matt said I called him at work at 4:00 and asked him to pick up a pizza for dinner and he brought it home at about 6:00 and found me unconscious on the couch having a seizure.  He immediately called the ambulance.  I got IVs of glucose because I couldn't swallow anything.  This was the scariest of the events because I have no idea what I did all day.  I don't remember anything past 2:00 and yet I called Matt and had a conversation with him at 4:00, and he did not notice that anything was wrong.  I have no way of knowing what time I went on the couch, but from 2:00-4:00 I know I must have been awake...what did I do? 

The fourth time was just in January.  We had a 2 hour delay from school because of snow.  I remember getting the first phone call from the school which was around 5:30 am.  I told Matt that there was a delay and went back to sleep.  I heard Matt get up and leave for work.  Then the school called again (around 8:00??) and said that school was canceled.  I remember yelling, "BOYS!  School is canceled!" and that is it.  When I woke up again there was commotion in my room, Matt was there, our old neighbors (the EMT's) were there and I had no idea what was going on.  I remember drinking some orange juice.  Matt said I was crazy, combative and hitting him and yelling at him.  After I drank a few swallows of juice (he said I refused to open my mouth for anymore ~ don't remember any of it) he tested my sugar a few minutes later and it was 34.  That was AFTER orange juice.  I got taken out to the ambulance and to the ER again.  I started to come around a little bit when I was getting put into the ambulance and did have a conversation with the EMT's.  I was sent home about 2 hours later, extremely embarrassed, clothes still wet...stupid sweat fairy again.

Every single one of those times I was so lucky.  Lucky that someone came over and found me or called.  I truly believe that if Matt hadn't shown up when he did the night he brought the pizza home, I would have died.  What scares me the most is that each of these times I was at home alone with my 3 kids.  Thankfully my kids are very independent and the older two take good care of their little brother. 

My CGM beeps at me when my blood sugar gets below 70 mg/dL.  It will beep at me again if it gets below 55 mg/dL.  It wakes me up during the night so that I won't have major problems with low sugar in the morning (which is what caused 3 out of 4 of my major events.)  If I was unable to wake up and push one of the buttons, it would continue to BEEP BEEP BEEP so that it would wake Matt up and alert him that something was wrong with me. I still need to check my sugar on my regular glucose monitor (in order to calibrate my level with the CGM) but I don't mind doing that because having my CGM has definitely made me feel more secure, even if it is a little more work!