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Going to the Pool with a Dexcom Arm Site

Last week I went to the pool for the first time with a Dexcom arm site. This is actually the first time that I’ve gone to the pool with a Dexcom in any site.

I wasn’t really concerned about people seeing the Dexcom in my arm and being freaked out about being in the water with me while wearing it. I’m not going to lie, there are times that I get freaked out when I see people with scabs and band-aids and bandages on while in the pool. Frankly, I don’t know why they have those bandages, so I don’t know what could be getting passed in the pool.

My biggest fear was that it was going to fall off while I was swimming and that I wouldn’t feel it and then my transmitter would be lost and that would not be good.

Neither of those things happened.

I was happy to be wearing my CGM while in the pool because the pool typically drops my blood sugar quite quickly. I wasn’t doing any strenuous swimming, it was more just following my daughter around in the kid section and getting a few moments to dip my head under the water.

Blood sugar stayed pretty steady, but it’s great to be able to know that real time.

I was also very happy with the sensor tape that held up. There were no issues with it peeling or coming off at all.

In fact, that was day number 10 or 11 and it was still holding on tight.

All-in-all, it was a great first experience wearing my Dexcom to the pool and it was even better with it being on my arm.

Diabetes in a Cave

Even though the title may sound like I was trapped in a cave with type 1 diabetes, that’s not the case. Although, that would be one hell of a movie, if Hollywood could get it right of course.

Anyway, we decided to take a family trip to Crystal Cave out near Kutztown, PA with myself, wife, daughter and my brother’s family, including my niece who also lives with Type 1 Diabetes.

I have never gone into a cave before, so I was not 100% sure what to expect.

I was told that the tour would take about 45 minutes in total, so I assumed a lot of walking. Because of that, I wanted to keep my BG at about 200 before entering the cave that way I would hopefully not have to correct while I was on the tour.

Start of the Tour

We were starting the tour around 12:45 and I did not eat lunch yet, jut breakfast and decided to have a few of my daughters chips before heading into the cave for the tour.

The tour started with a 10-15 minute video explaining the history of the cave and how the cave was formed and what some of the things we will be looking at inside the cave are. Once the video was over, it was time to head into the cave.

I knew going into this that the cave was going to be cold, and it was. It was a constant 54 degrees, which that’s actually not cold to me, that’s perfect temperature.

For me, the heat drives my BG straight down, so I knew the cool, damp climate inside the cave would not be effecting my blood sugar.

The tour was slow, meaning that we walked about 20-30 feet and would then stop at the next station for them to explain what we were seeing. During this time my blood sugar was staying around 200-220 and pretty flat and steady.

The walking part of the tour lasted about 20-25 minutes and when I walked out of the cave my BG actually went from 200 to about 245, so there was no drop at all from the activity of walking through the cave. Grant it, there really wasn’t any steps or much walking uphill. There was only one section that we could opt-in to walk up to the highest point of the cave, which was maybe 30-35 feet high.

As soon as we got out of the cave, I asked my sister-in-law what my niece’s blood sugar did while in the cave. Her answer, “stayed flat”. Exactly the same that my blood sugar did.

Lunchtime

It was then time for lunch and I was hungry and started eating before I took my insulin. Actually, I finished my entire meal before I took any insulin.

What happened next… I’m sure you can guess that.

A straight shot up like the mountain we were standing on. And that BG of over 350 lasted for several hours and made me feel like crap.

Luckily, after the cave, we went to pick strawberries and it was getting hot, so that helped bring the BG down a bit too.

I’ve been doing much better at pre-bolusing and this was an example of exactly why the pre-bolus is so important.

All in all, the cave adventure was fun. Check out some of the photos below.

t slim x2 basal iq diabetic blog

Tandem t:slim X2 Basal-IQ Technology Predictive Low Glucose Suspend

I wasn’t able to attend the ADA’s Scientific Sessions this year, even though it was in Orlando. If I was still living in Florida, I most likely would have went, but a 2.5 hour drive is a lot different than a 2.5 hour flight.

There has been a lot of news coming out of ADA. Which, I will just never understand. I know that there is a lot of attention and PR going on about the event, but wouldn’t you want to announce your big announcements before it or even a little after?

There were some huge announcements and then 30 minutes later another huge announcement hit the press wave and now your announcement is not getting as much attention.

I know it’s just how PR has always been done, but it just doesn’t make any sense to me. You’re wasting your attention span.

Anyway, back to the point of this post. Today I am going to write about the Tandem announcement and tomorrow will be about an implantable CGM device.

Tandem Diabetes Care

So, Tandem announced the approval of their t:slim X2 insulin pump with Basal-IQ Technology. What does that all mean?

Well, as I mentioned, I don’t have the full tech details because I wasn’t there to ask questions, but from what I can gather, this is what it is.

The t:slim pump will integrate with the Dexcom G6 to create a predictive low glucose suspend. This seems to be very similar to what the Medtronic 670G does already, but this is huge news because it gives Dexcom users and t:slim users the same opportunity without having to switch from their beloved products.

tandem tslim basal iq technology insulin pump

 

Tandem’s Basal-IG algorithm will be able to “look” 30 minutes into the future to help predict a low blood sugar. This would then activate the predictive low glucose suspend and the insulin pump will suspend insulin delivery and then begin again once levels start to rise.

This device should be available in August 2018 according to the press release.

Please note that everything I mention above was mentioned in the official press release.

What is awesome about this is that if users are currently already using a t:slim X2 insulin pump, they don’t need to worry about upgrading to a new pump. When I was using the 630G, the 670G was approved about a month later, but I couldn’t make the switch to 670G right away. I eventually did in order to try it, but it took a long time.

With the t:slim X2, users can easily update their software free of charge to include the Basal-IG Technology.

I decided at the beginning of the year to go with Dexcom and MDI.

This is definitely exciting and I know that a lot of people were waiting for this announcement. I’m super happy for Tandem and look forward to hearing more great things about this.

Darn you Tandem for now making me re-think my decision.

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24 hours with dexcom in arm

24 Hours with a Dexcom Arm Site

I’ve been wearing my Dexcom on my arm now for 24 hours. My initial 24 hour thoughts, I love it!

Here’s a video of me inserting it myself, with a little help from my wife after I realized that I needed some help and practice doing it all myself. I had the insertion part done pretty easily, but getting the needle part disconnected was very difficult.

I inserted in my arm and had to have my wife put the sensor tape on because there is definitely no way that I would be able to do that myself. Maybe one day, but not any day soon.

The accuracy has been spot on. The comfort level has been great. I actually keep forgetting that it’s even there, which has caused me a couple of potential issues.

I’ve knocked the transmitter on the door jam a few different times. One time I hit it pretty hard and noticed that I started receiving ??? A little while later. Well, the transmitter was actually knocked loose a bit, which is why it wasn’t getting any readings.

Once I pushed the transmitter back into place, it started working great again.

I went tot he gym and was wearing a long sleeve shirt, which created even more moisture and everything held up great.

Sleeping the first night with the Dexcom arm location was a concern, but it actually went perfectly fine. I sleep on my side (as soon as I go to my back, I get an elbow from my wife because I snore way too loud), so I thought that maybe it would be uncomfortable or that I would rip the Dexcom out after rolling around in my sleep.

Didn’t happen.

Let’s see how I feel after a full 7 days, but after 24 hours, I’m sold.

2 arms and 2 under the breast area will be 4 spots, that is the rotation that I need. In fact, as of right now, I may want to stick to just the arm, but I don’t know if that will end up being a problem with only using those two spots.

We will see.

Until then.

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Dexcom Keeps Falling Off

I’ve been having a bad streak with Dexcom lately. I haven’t had one stay on for more than 4 days in my last 3 attempts.

The issue is NOT the stickiness of the tape or the Medtronic sensor tape that I use over it. The tape is still stuck perfectly to me. In fact, when I have to take it off, it hurts because the sticky tape is still pulling at my skin.

The issue is that the sensor itself, the middle part of it where the transmitter is attached comes out of my skin. So, the sticky parts are still intact and holding strong, but the sensor itself comes out of my skin.

Now, I don’t know if this is just because of where I wear my sensor (just under the breast area), which I just recently wrote about, or if I just have a bad batch of sensors in this box.

Also, I haven’t called any of these issues in. I know that Dexcom would replace them, but I don’t take the time to call the issues in. I guess it’s more of a timing issue than anything. I just don’t have the time to sit on the phone with someone.

So, I do wish there was an easier way to send in an error or issue. For example, when I click on start sensor, and just 4 days later, I have to hit “Stop Sensor” on the iPhone app, something bad actually happened to that sensor for me to stop it, so it could more easily start the process of sending me a replacement.

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Well, now I am just getting off topic a bit here. Back to the sensors falling off.

Has anyone else had these issues? Remember, it’s not the sticky part, so I don’t think that Tegaderm or any other type of tape is going to help. Unless of course I put tape over the actual transmitter, but from my understanding, I can’t do that because it’s going to effect the connection between it and the iPhone.

Does any one know if that is true or am I just making that up?

After having only 4% time in range in my last weekly Clarity report, I really needed the Dexcom on during this week of eating low carb so I can build a little bit of confidence in my diabetes management and not just say “eff it” like I have been feeling like doing lately.

So, adding these falling off issues, it’s not making my burnout get any better.

Here’s to finding a solution to my problem.

switching rx from walgreens to cvs

Prescriptions Running Out and No More Scripts

Since I moved to a different state a couple of months back, I was able to change my Marketplace insurance in the middle of the year. Unfortunately, I now have to switch back to CVS from Walgreens, which is where all of my prescriptions are at.

I unfortunately cannot get in to see my new endo until the middle of August and my old one is not going to send any more prescriptions because the last one was the last because I moved. But, there are still two 90 day refills left with Walgreens, but I need to try and get them transferred over to CVS. I really, really hope that I can do this.

Has anyone had any experience in this?

This is one thing that I thought I timed up perfectly, but I guess I didn’t. I knew that my old insurance was going to expire on at the end of May and that my new insurance would kick in starting June 1, however, what I didn’t expect to happen was to have such a long waiting period to see the new endo.

I should have known that was going to be the case though because there is always a long waiting period to be seen as a new patient.

Luckily, I don’t have any issues with insulin, for now. I should be good on that until I see the new endo, but I am going to still try and get the prescriptions switched over.

I’ll keep you updated.

dexcom and insulin site rotation

Dexcom and Insulin Site Rotations

I’ve been wearing a Dexcom and using MDI now for about 4 months now. I am already starting to feel the site rotation woes of using MDI and a Dexcom.

I currently have been wearing my Dexcom in the same two spots, just switching back and forth every 8 days or so. That location is just under my breast area. It sticks and stays for the full length and I’ve only had one fall off before the actual 7 days.

I haven’t attempted the back of the arm location for the Dexcom yet for two reasons. One, I haven’t felt comfortable trying to do it myself yet. Two, I use that area for insulin injections a lot.

A lot, a lot.

Courtesy – Novo Nordisk

MDI Rotation

That’s now causing a problem for insulin pen injection rotations as well. I usually switch between my arms and my thighs, but lately I’ve been having a lot of issues injecting insulin into my thighs.

I don’t typically use my stomach, because I feel like it’s just not effective there. Especially since I haven’t been to the gym since I moved almost two months ago. I’ve also gained more weight, so that’s not helping the stomach issue either.

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Dexcom in the Leg?

I only tried to insert a Dexcom sensor into my thigh one time and it bleed bad, really bad, so I haven’t had the guts to try it again.

Does anyone wear their Dexcom sensor on their thigh? How about on the side of their leg near the hamstring area? I would try wearing it on my lower back, but I’m not sure how that would feel all day long working in a chair.

Also, I’m not quite sure that my wife is ready to insert a Dexcom sensor for me either.

When I have these sensor site rotation issues, the same thing happens every time.

I just decide to skip wearing the Dexcom altogether and go without a CGM. Going without a CGM does not make my wife happy.

Happy wife, happy life.

So, I need to figure this site rotation thing out.

Stomach Placement for Dexcom

I haven’t used the Dexcom on my stomach because of all the rolls on my stomach, so I’m afraid it will just fall right off. I guess the tape that I use will really be put to the test if I try and put the sensor on my stomach finally.

If you wear on your leg, please let me know how that has worked for you…front or back. If you have a lot of fat and rolls on your stomach and have successfully worn on your stomach, please let me know that too.

Searching for a New Endo (or ARNP) and I Don’t Like It

Something that I haven’t really talked about on the blog or on social media is that my wife and I have moved recently. A pretty far move in fact. This post is not going to be about that.

I am writing this today because I now have to choose a new endo for the first time in 15 years.

Same Endo / ARNP for 15 Years

When I first moved to Florida to go to college, I met with an endo, which was in Boca Raton – the senior capital of the world, and within 5 minutes he said the first thing he would do is take me off an insulin pump and I walked out before he could finish the visit. I paid my co-pay and left.

I was then put in touch with an awesome Type 1 endo and loved my time with her, which was for 2 years, but stayed at her office because they had someone new coming in that I heard of before. At the time, I was interning at a diabetes supply company and I had attended a CDE accreditation course and this lady was the teacher who was teaching CDEs!!

So, I knew that I wanted her to be my doctor.

The weird part, at first, for me was that she was not an endo. In fact, I have not seen an actual endo in over 10 years.

Photo Credit – http://www.workercareclinic.com/blog/what-is-an-arnp-2/

She is an ARNP, which took me forever to remember what that stood for. ARNP stands for Advanced Registered Nurse Practitioner. She was also a CDE and the most knowledgeable person on diabetes that I have ever met.

I had the greatest doctor – patient relationship with her. She listened to me. She let me lead appointments. She drew charts of insulin activity on the white paper that is pulled over the patient seat. She was absolutely incredible.

She let me sample everything. She told me about new studies, new books, things from ADA and AADE, she even provided me with a lot of resources when I was stressing about having a kid.

At the same time, she also let me make a lot of excuses. She would cut my excuses down and put me in place when need be. For example, when I kept fighting her on going on blood pressure medication and she spent an extra 30 minutes during her lunch break to explain to me why I needed to be on the meds, no one else would have done that.

The Search is On

So now, I’m back to having to find someone new and start a whole new relationship. I feel like I’m breaking up a relationship of over 10 years and starting fresh.

How do I walk into an appointment and say, listen, I have a lot of knowledge, I’m not your typical patient who is just going to say how high when you say jump. We need to have a relationship, not a dictatorship.

I am back living in the same area I was when I was first diagnosed, so I could possibly see the same endo I saw when I was first diagnosed. I’m 80 pounds heavier and A1C is not so great and I haven’t exercised in over a month now since the move, but hey, I probably do need a serious reality check.

I will definitely miss the “celebrity” treatment I received in the other office.

This is also a time for me to put into work all of the tips that I have given over the years of how to become an empowered patient and creating a relationship with your doctor that is healthy.

I’ll keep you all updated.

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Better Sleep Equals Better Health – Nectar Sleep Review

One thing that I have never had is good sleep. I’ve always been one to go to bed at 1-2 in the morning and wake up at 7 am and get the bare minimum sleep just because I needed to sleep. The more that I realized this was horrible for my health and that my morning blood sugar spikes could be related to poor sleep.

I am still guilty of going to bed late at night, but I am getting much better sleep now, a lot better!

And that is all due to the fact that I decided to trial the Nectar Sleep memory foam mattress and it is absolutely amazing!

I have the Queen sized mattress from Nectar.

Queen Memory Foam Mattress

I’ve never slept on a good mattress before. Discount sales for mattresses have always been the way to go. This is one of the first memory foam mattresses that I’ve owned, and it came with 2 memory foam pillows and wow, I am in love.

When I actually lay down to go to sleep, I am out. I am not tossing and turning like I used to in the past, but just go right to sleep. When I wake up in the morning, the days of having a stiff neck or sore back are also gone. When I do turn in the middle night, my wife doesn’t feel it at all.

The memory foam pillows are spot on as well. I would have never thought to use a memory foam pillow, but now that I have one from Nectar Sleep, I will never go back.

So, Nectar Sleep offers a 365 night trial. Yes, you heard me right, a 365 night trial. You can sign up here to start your 365 night trial for free.

It will arrive in a blue Nectar Sleep tubular bag. Caution, it is a bit heavy, so you may require two people to carry it.

Once you open the bag, it is very easy to set up. Be sure to place the mattress where you want it to be. You don’t have to put it on a bed frame at all if you don’t want to. In fact, I would recommend letting the mattress unfold and breathe directly on the floor.

 

It is incredible how this amazingly comfortable mattress came in such a small package.

I was always hesitant about these beds until I actually own one.

We decided to put our mattress on a small metal bed frame because we needed the storage room underneath the bed.

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So how has the mattress helped with my health?

For one, the extra sleep has provided me with more energy when I wake up in the morning, which ultimately means less caffeine is needed.

My blood sugars still see a spike in the morning time (always have), but on nights when I get a great night’s sleep, they don’t seem to spike as much in the morning time. So, I’m not a doctor or a scientists, but I can put 2 and 2 together, better sleep = better BG activity in the morning.

Links above may include affiliate links which result in me earning a commission on any purchase made at Nectar. These commissions help to keep this blog running and allowing me to share useful information with you.

Novo Nordisk Social Media Summit Discussing Insulin Pricing and More

I am a little late to posting my thoughts from the Novo Nordisk Social Media Summit that took place earlier this month. I must first start off by saying that Novo Nordisk paid for my roundtrip airfare, hotel, meals and provided full access to the Indy Grand Prix at the Indianapolis Motor Speedway.

I arrived on Thursday evening, but the summit didn’t begin until Friday morning.

On Friday morning, we started out with introductions of everyone in the room and a quick overview of what we were there to discuss.

Insulin pricing was obviously going to be one of the primary topics of discussion. As expected, there were a lot of questions and a lot of confusion as to why it is not just a simple task of lowering the costs of insulin. Why are people dying? Why can’t people afford a life saving medication?

During this conversation there were some slides and information that was shared with us. One of those was a link to Novo Nordisk Position on Pricing and Affordability, which I honestly have never seen. You can find that here – http://www.novonordisk-us.com/whoweare/about-novo-nordisk/our-position-on-pricing-and-affordability.html

One of the questions brought up was why the list price of Novolog has continued to go up year after year after year. One thing that I found interesting was a graph that was shown comparing the increase in the list price compared to the net price, meaning what the price actually is after all the costs and payments and rebates, etc are taken out. These lines have actually stayed relatively flat!

That was very insightful to me. That because of increase in outside costs (PBMs for one), the list price had to be increased in order to keep the net price out of a negative.

I think that this is one of the areas that people don’t understand. They don’t understand the entire system. Most people think of insulin as a direct to consumer product and it’s not. It’s not an iPhone that Apple can just lower the price of and then the consumer sees that direct decrease in pricing.

That leads me to the next image of the complexity of this system. Just take a look at this convoluted system and tell me how “just lower the list price” works here.

Now, I want to state here again, because I’ve been accused of not caring about insulin pricing, that I want the price of insulin to be lower. I just know that it’s not as simple to lower the list price and then everything will be fine. There will be loss of access to insulins because they will be removed from formularies. Not all insulins will be removed, but access will be lost for a lot of people, so we have to find the fine line between access and affordability.

This is a systemic issue and a healthcare related issue that needs more of a solution than just lower the list price. And I really wish that the protestors that are out there could just simply learn how to have a conversation and not just shout at people who may say something they don’t agree with.

I will get more into the insulin pricing in another post, but I wanted to touch base on more about the summit.

Final thoughts on insulin pricing for this post is this. Know the battle you are fighting, the whole battle, not just what you think is going on and come to the table with a solution, not just a cute phrase to shout at a picket line.

Other discussions that we had at the summit between Friday and Saturday discussed Type 2 Diabetes and the Get Real About Diabetes campaign that Novo Nordisk started. You may have seen something about it on the ABC show Black-ish.

We then also talked about the Race with Insulin campaign and Charlie Kimball. If you are not familiar with Charlie Kimball by now, he is an Indy Car driver who has type 1 diabetes. We also attended the practice sessions and the Indy Grand Prix race on Saturday.

I left the race early and then headed to the airport to head back home just in time for Mother’s Day, which I am still making up for that because of being tired and exhausted all day on Mother’s Day.