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Category: Dexcom

Pre-Bolusing for the Win

Chris Stocker 1 Comment

I have been trying many different ways to better manage my diabetes. I have written about setting much lower targets for my Dexcom (170 as the high). This is because I want to have an A1C below 6.0. Also, as I’ve mentioned before, save the “A1C doesn’t matter”, no, it’s not the only thing that matters, but it is a way to see how well I did the past 90 days.

The other thing that I have been doing is actually trying really hard to pre-bolus. As I just wrote that sentence, I was about to edit it to get rid of the “trying really hard”, but I decided to keep it in. I’ve never seen Star Wars or Star Trek or whatever it is that Yoda says something like, “There is no try, only do”

I don’t know the background of that phrase, but I have heard it a lot. And I love it.

There is no “trying to do” something. You just do it or you don’t. You may not do it well, or you may not do it all the time, but you just need to do it.

That’s the route I have taken with pre-bolusing.

I’ve always had every excuse in the book.

“I’m too busy, I don’t know when I’m going to eat”

“My schedule is hectic, eating is never planned”

“Blah, blah, blah, blah, BS, blah, blah”

I do work a lot and I have a very hectic schedule. Managing Type 1 Diabetes, owning 3 companies and actively managing them takes up a lot of time. Luckily, my wife has taken over the cooking dinner duties and she gives me a 10-15 minute heads up. This has helped a lot.

When she gives me the heads up and tells me what’s for dinner, I can plan ahead and pre-bolus.

When I go to restaurants, I never knew how much I would be eating. I would eat mine, then my wife’s leftovers and maybe some of the kids, plus the appetizer, and maybe get dessert. So, a lot of the time, I would just eat and then take a crap load of insulin later. This would obviously create a massive spike and create a high blood sugar that took hours to bring back down.

Now, when I go to a restaurant, I look at the menu and order and then go take a shot, either at the table or in the bathroom.

Pre-bolusing has really allowed me to cut down on the after meal spikes. They are still there, but instead of shooting up into the 300s, I may only go up to 200. That is a huge win for me. I spend so much time out of range because of the huge spike after a meal and how long it takes for me to get back into range.

My daily graphs always include a spike, a drop, a spike, then a drop. Very rarely are my graphs just straight. My time in range currently is spent either climbing high or dropping low.

What made me really start pre-bolusing and making it a habit is a conversation I had with Scott Benner, who you may all know as Arden’s Dad or from The Juicebox Podcast. He had said to me (this is not an exact quote because I have horrible memory. I will reach out to Scott and ask for an exact quote),

“Yes, your diabetes may vary, but there are fundamental concepts that exists for all people with diabetes. Pre-bolusing just works.”

And I thought to myself, ya know what, that is right. There’s a reason you are told to pre-bolus and take your insulin 10, 15, 20 minutes before eating. It takes time to work.

This is also one reason why I was a huge fan of Fiasp and hope to go back on it once my insurance decides to cover it.

Well, that’s all for this topic. Pre-bolusing has done wonders for me. It was not something that I took seriously and since I have, it’s been a two-thumbs up for me.

Going to the Pool with a Dexcom Arm Site

Chris Stocker 1 Comment

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

Chris Stocker 1 Comment

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

Chris Stocker 1 Comment

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

Chris Stocker 1 Comment

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

Chris Stocker 2 Comments

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.

dexcom and insulin site rotation

Dexcom and Insulin Site Rotations

Chris Stocker 2 Comments

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.

50 Days with Dexcom Clarity

First 50 Days Analyzed with Dexcom CLARITY®

Chris Stocker 1 Comment

I’ve had the Dexcom for about 2 months now, I think it’s 50 days to be exact, but, who’s counting. I am a huge fan of data. I like data, but sometimes too much data can just complicate things. That’s one reason that I love Dexcom CLARITY®.

I can get a very quick snapshot with a visualization of my time-in-range and average glucose over the reporting period and then move on with my day. Or, if I wanted to, I can dig deep into patterns and issue areas.

I get a weekly email with my previous 7 days data and my time in range. I don’t even need to click through to anything, the email just appears.

Dexcom Clarity Weekly Email

 

I’ve been using the Dexcom CLARITY® iPhone app to view all of my data. But, for the big 50 days of data and for today’s post, I figured I would actually look at it on the regular website.

So, let’s take a look.

Here is an overview of the last 50 days. As you can see it includes:

  • Average Glucose (from the CGM)
  • Standard Deviation
  • Hypoglycemia risk
  • Time in range
  • Sensor Usage
  • Patterns

Time in Range

When I look at this overview page, the first thing that I look at is the Time in Range. As you can see, I only spent 33% of the time in range. With 66% of that time being high. That just goes to show that it’s so much harder to bring down a high than it is to bring up a low.

I am not happy with the 33%. It is a pretty number because it is exactly 1/3 of the time has been spent in range. Unfortunately, that’s not where I would like it to be. My goal is to spend at least 50% of my time in range. Once I hit that goal, then the next goal is to reach 66%, then 75%. I know that I won’t reach 100% time in range, but if I can stay above 75% consistently, I will consider that a win.

Now, I did tighten up my ranges during this period as well. I moved my “high” range down from 250 to 170. So, any number above 170 is considered out of range.

Average Glucose

The next number that I look at is the Average glucose. As you can see above, it was 198. That also is not where my goal is, but it is better than the previous 90 days. My last A1C taken in February was 8.2. My goal was to be below 7.5 by the time the next one came. 198 is about a 7.7 A1C level I believe? Not at my goal, but with all of the exercising that I have been doing combined with me facing my eating problems, I feel like I can definitely bring that down quickly.

Standard Deviation

Standard Deviation is not something that I really look at, mainly for two reasons.

  1. Standard deviation problems in college always were hard for me and it confused me, so I just don’t pay attention to it. My understanding is…the higher it is, the worse it is. But, I don’t know if 65 is good or not? Someone out there reading this, can you help?
  2. I don’t know what to compare this to. I can track this over the months and see if it comes down and then I’ll know if 65 is good or not.

Days with CGM Data

The next piece that I look at is the days with CGM data. As you can see for the last 50 days, it was only 33 out of 50 days, so 66% of the time. I took my 24 hours of being naked time and then took about another week off. How I missed 17 total days…that I don’t know. I’d obviously like that to be much higher. That one I can easily control.

Patterns Found

The last thing that I look at in this overview page is the patterns that were found by Dexcom. As you can see above, there were 2 patterns.

  1. A pattern of nighttime highs
  2. A pattern of daytime highs

That sounds like 2/3 of my day, just like the time in range report stated.

I have a problem with morning highs. My blood sugar just spikes as soon as I wake up, whether I eat anything or not. The nighttime highs are primarily due to the fact that if my blood sugar is about 200 or so during the night, I usually don’t wake up to take a shot. Once again, that is something that I can work on myself.

My Best Day

The final thing listed in this overview report is a link to my best day, which says I spent 80% of the day in range. I wish I knew more about that day and what I ate and what I did so that I can mimic that day.

 

Here’s a snapshot of that day:

 

So, that’s it. That’s the overview of the first 50 days of data with Dexcom.

These quick overview reports give me everything that I need to know in order to make changes. If I want to dig deeper (which I will), I can look at exactly what time of day am I most out of range vs in range and figure out what I’m doing at those times.

I will use everything that I learned from Bright Spots and Landmines.

 

naked for 24 hours with diabetes

I Was Naked for 24 Hours

Chris Stocker 1 Comment

Don’t worry, despite the title, this is a PG-13 blog post.

In case you have never heard the phrase “naked” used in diabetes before, it simply means, going without any devices attached to you. So, no insulin pump infusion sets, no Pods, no CGM sensors, nothing.

The last 24 hours I have indeed been naked.

As you may know, I have started on the Dexcom. I’ve been using Dexcom for a little over a month now I believe (My thoughts on Dexcom, 1 month later post coming soon). I absolutely love my Dexcom and I actually don’t like not having it on at all times now.

But, the sensor was ending, I was in a hurry and just thought, I’m going to go naked for a day.

This is my first full day going without wearing Dexcom since I have started on it. When I used the Medtronic CGM, I would sometimes go months in between wearing it. Why? I don’t know.

It felt a bit weird going to the gym and not being able to see what my blood sugar was doing during that time. It was also weird seeing my BG at about 170 before eating and then seeing it at 320, 2 hours later and not even knowing that it spiked like that. I wasn’t able to catch a high before it went even higher.

The good news is that I am a One Drop user, so I have unlimited test strips. And when I say unlimited, I mean unlimited. I can test 20 times a day if I really wanted to.

So during this 24 hour period, I decided to test more often (I think I hit 12 times) so that I could see those spikes and trends coming before it was too late.

Unfortunately, the lunch one I didn’t catch because of meetings right after eating.

I like having a naked day at least once a month to just feel free. But as I mentioned above, I also feel lost without the CGM data. I also am not obsessing over my BG levels all day long either when I am naked, I sort of just go with the flow.

Do you ever like to just go naked (keep it clean folks) and disconnect from technology when you can? If so, do you have a plan in place? Do you have a certain time frame you are willing to do it for?

I’d love to hear your stories.