Yearly Archives: 2015

Considering the Dexcom G5 Upgrade

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Laddie_Head SquareFor the first time in my diabetes tech history, I am in the golden upgrade zone. The FDA approval of the Dexcom G5™ Mobile CGM System was announced the same week that my G4 warranty expired. According to Dexcom’s upgrade program, I am entitled to a free upgrade to the G5 system if I purchased my G4 Platinum System with Share before the G5 begins shipping.

It was a no-brainer to order my new G4 system as soon as possible because I never want to run the risk of out-of-warranty equipment failing. Due to good insurance and the CGM rep at Edgepark (yes, I always have great service from Edgepark unlike so many others who report horror stories), my new CGM arrived within a week. At this point I began doing my homework about the upgrade options.

As I learned more about the G5 system, it quickly became apparent that it was not a slam-dunk decision to upgrade. I’ll discuss a few of my concerns below.

Pros of Upgrading

One Less Device:  I joke about diabetic pants and never buy clothes without pockets. I currently carry an insulin pump, glucose tabs, Fitbit, Dexcom receiver, occasionally car keys, and often my phone. The possibility of eliminating the Dex receiver is appealing.

Optional Receiver:  If I don’t like using my iPhone as my receiver, I can always use the G4 Share receiver updated with the G5 software.

Sunlight:  The G4 receiver with its black background is difficult to read in bright sunlight and the red color used for lows is almost invisible. My Animas Vibe pump is even worse and the text is totally unreadable in bright light. My phone has a better display and is easy to see in all light conditions. (Note: Now that I have the Share receiver, I have the option of using my phone without upgrading to the G5, but I would have to carry the receiver.) Because the G5 software upgrade will result in a new receiver display with a white background, maybe it will be easier to read in the sun than the current G4 device.

“Free” G4 transmitter:  Because my current G4 system is working, I have not had to Golden Upgradeopen the new G4 transmitter. I do not have to return this transmitter when I get the G5 transmitters and can keep it as a back-up to use with my current non-Share receiver. This is appealing as I get close to Medicare with no coverage for CGMS.

The Price is Right:  The upgrade is free!

Cons of Upgrading

Expiration of G5 transmitters:  My understanding is that the G5 transmitters will last 3 months and drop dead after 108 days (90 days plus an 18-day grace period). If you have good insurance coverage for CGMS, this is not a big deal. With no CGM coverage, the loss of an extended life for a transmitter can be a big deal.

Bigger Transmitter:  The G5 transmitter has built-in Bluetooth and is bigger than the current slim G4 receiver. It is about the size of the first generation G4 transmitter.

Not Compatible with Animas Vibe:  Although I rarely use my Vibe as a Dex receiver, I like having the option especially when I want a waterproof receiver at the pool or beach. Because Dex transmitters cannot be turned off, it’s expensive to use a G4 and G5 transmitter concurrently. I assume the lack of G5 compatibly will also extend to the new Tandem t:slim G4 combo.

Disadvantages of Phone Receiver:  My phone is much larger than the Dex receiver and doesn’t fit into many of my pockets. Although I use my phone a lot, I do not keep it with me day and night. I have no idea whether the sounds and vibrations of CGM alarms on the phone will be adequate. It will take more button pushes to access BG data on my phone compared to the one-button push of the Dex receiver.

Other Thoughts

Medicare:  I currently have excellent CGM coverage with private insurance. When I move to Medicare in April 2017, I will have to self-fund a CGM unless Medicare regulations change. My guess is that a G4 transmitter with the Animas Vibe or the Tandem t:slim G4 will be the least expensive option because no other receiver is required. As discussed in my April 2015 review of the Vibe, I am not a fan of the Dexcom integration into the Vibe. But it works and is an option. As far as I know, both pumps will continue to use the outdated G4 software instead of the 505 update.

It is possible that under Medicare the G5 will be an equally cost-effective device if I do not need to purchase a new receiver every year. The G5 was approved by the FDA with the requirement that a receiver be provided to new patients. Is that a one-time requirement or will G5 users be required to purchase a new receiver every year when the old one (maybe unused) goes out of warranty?

Staying Current:  New CGM devices are gaining FDA approval at a much faster pace than in the past. It is likely that both the G4 and G5 will be outdated in a few years and maybe my current decision is just not a big deal. With the Animas Vibe and t:slim G4 tied to the G4, my guess is that the original G4 transmitter will be available for many years to come. The G5 may be a short-lived device on the way to the G6 which promises improved accuracy and reliability along with mobile capabilities. Another consideration is what the new Dexcom/Google collaboration will bring to the table.

Decision Deadline:  The Dexcom website indicates that “Upgrade offers are available until 60 days after the first G5 Mobile shipment.” However, I learned that because I purchased my G4 Share system through a distributor (Edgepark), I have only 30 days from the date of shipment to upgrade. I am looking at an upgrade deadline of early October rather than late November. Good thing I asked!

My Decision

I have decided to upgrade and will be sent my G5 transmitters in October. At this point I will upgrade my Share receiver to the G5 software. For the most part I am choosing to abandon my Animas Vibe as a receiver and become more hip by never again being separated from my phone. Frankly I don’t know whether this is the right or wrong decision or if it even matters. Dexcom is making the change incredibly easy and I have just decided to go with the newest kid on the block. If nothing else, I am thankful for having the #firstworldproblem of choosing which CGM system to use. I promise to let you know how it goes.

The Dexcom in Poetry

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Laddie_Head Square

You are probably familiar with the poem “There was a Little Girl” by Henry Wadsworth Longfellow (1807-1882). The first verse goes as follows:

THERE was a little girl,

And she had a little curl

  Right in the middle of her forehead.

When she was good

She was very, very good,

And when she was bad she was horrid.

*

When I started this post, my aim was to compare my Dexcom G4 CGM to the little girl. I am a huge fan of my CGM and most of the time it is a trustworthy and reliable device. But occasionally it shrieks, spews out bad results, and stomps its little sensor feet just to remind me that it is imperfect and I shouldn’t expect constant excellence.

Screaming Girl

The more I looked at this photo, the more I began to realize that I was seeing my own reflection rather than my Dexcom. I can be very good at making optimal decisions when it comes to things like diet, exercise, and insulin. The “Good Me” takes the normal ups and downs of Type 1 in stride and spends a lot of time in range. Unfortunately the “Horrid Me” takes over at other times and makes bad decisions amidst frustration, self-criticism, and just not giving a damn. I feel helpless with my BG numbers and want to scream, throw things, and live a self-destructive life eating chocolate-covered donuts.

Dexcom: The Very Good:  In mid-August I had severe bronchitis and was prescribed oral steroids. As is typical with steroids, I experienced a huge rise in blood sugars and at one point was taking 5 (!) times my pre-steroid dose of insulin. Although I wasn’t seeing low blood sugars, I was worried about sleeping with such massive amounts of insulin on board. Adding to my vulnerability was the fact that my husband was out of the country on a business trip.

During the five days of steroids, my Dex G4 was as accurate as I have ever experienced as it tracked my blood sugars in a range from below 100 to the high 400’s. Most importantly it provided a safety net that if my BG tanked at night, it would repeatedly alarm until I responded. Without the CGM, I would have been terrified to be alone and probably would have needed to set hourly alarms to check my BG day and night.

Dexcom: The Very Bad:  Ten days ago I started a new sensor. I know that the first 24 hours of any sensor can be wonky, but this sensor site was the worst. Double up arrows in the high 200’s followed by double down arrows in the 40’s when my calibrated BG was between 100 and 125. Vibrations and alarms were driving me crazy. I finally turned off the receiver to give it a few hours to think about how it could improve. When I turned it back on, I continued to receive multiple alerts—some accurate and others absolutely unwarranted. Rather than throw the receiver out the window, I finally just turned off all of the alerts except for the low threshold. Eventually the sensor settled into reasonably good results.

Besides the occasional bad results of a new sensor, another thing that drives me crazy about the G4 is that after alerting me to a low, it continues to alarm long after my BG has returned to normal. Unfortunately that is a characteristic of the interstitial fluid that the CGM measures and I am not sure that there is a solution for this. But it would be nice if the G4 didn’t alert for a low when your BG is moving up:-)

Living with a Dexcom: The Good Me and the Bad Me:  Most of the time I live in harmony with my Dexcom. I do a good job of knowing when to trust it and how to optimally use the information it provides. One thing that I sometimes ignore is that the CGM is only as good as how I react to it. If things are rough in my diabetes life, I have the power to evaluate how I am using my CGM and make changes if necessary.

A lot of my recent frustrations with the Dex are related to alarm fatigue and data overload. There is not much that I can do to prevent a lousy sensor start or change the fact that interstitial fluid behaves differently than blood sugar. The Bad Me overreacts to sensor data and gets stressed by out-of-range BG numbers. I start making too many corrections that often lead to more erratic numbers. I start dismissing alerts without even looking at the receiver. I rage bolus to prevent highs. I eat junk food despite the inevitable cr*p results. I basically get burned out by diabetes.

The Good Me remembers that I am in charge of most of the settings on my CGM. After turning off most of the alerts last week, I lived with only the low alert of 70 for several days. I was amazed at how much less stress I experienced in relation to diabetes. I slept better and in general had improved BG numbers per my meter. I eventually turned back on the high alert, but at a threshold of 200 rather than 150. I didn’t change my personal goals for my BG range; I just reduced the Dexcom intrusions into my life. I look at my CGM often enough that except for the protection from undetected lows, maybe I am better off catching the changes myself rather than getting constant alarms for ups and downs. I have kept the rise and fall rate alerts turned off and have not missed them.

Summary:  If you have followed my blog for a while, you know that I was diagnosed long before home BG monitoring, insulin pumps, and even multiple daily injections. On one hand I work hard to have access to the latest and greatest technology. There is no doubt that my life with diabetes has been enhanced with the use of a pump and a CGM. At the same time I need to remember that beeps, bells, and whistles don’t guarantee good blood glucose numbers or mental health.

Currently I have turned off many of the Dexcom alarms and that is working for me. There is no guarantee that this will work for next week or next month. There is certainly no guarantee that it will work for you. But the only way to make things better when diabetes seems to be winning the battle is to try something new. Good or bad, it’s worth a try.

Please note that as I got this post ready to publish, my new Dexcom sensor alerted to a BG of 53. Two meter tests  of 100 and 106 confirmed my BG to be in range. Argh!!!

Pollyanna Faces Diabetes

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Laddie_Head SquareI have been accused of being “Pollyanna” when it comes to diabetes. I rarely complain about my dysfunctional pancreas and I am a firm believer that I only get one chance at life and I am not going to waste my time complaining. But sometimes I have to admit that DIABETES IS HARD.

I golf once or twice a week during my summers in Minnesota. Most of the time I play right after breakfast in the relative coolness of the morning. My home course is hilly and I am always tired when I finish my 18-hole walk with my clubs on a pushcart. Because I am in a rut and usually play the same course at the same time of day, I have for the most part figured out how to manage diabetes. Does that mean I never have lows or highs? Absolutely not. If my blood sugar is within a reasonable range before beginning play, does this mean I can get through a round without eating a couple of glucose tabs and maybe having a small snack? Nope, can’t do that either. But by planning my breakfast food and bolus insulin, using temporary basals, relying on my Dexcom CGM and an occasional fingerstick, I can play 18 holes with only minor blood sugar annoyances.

My standards for “diabetes success” on the golf course are low. Success means finishing the round without keeling over, needing paramedics, or getting so low that I can’t read the scorecard. Success means that my errant shots are the result of bad swings not the inability to control arms and legs wobbly from a hypo. Success means racking up lots of steps for the current Fitbit challenge. Success means that I enjoy my round and my playing partners don’t have to ask me if I am okay. Success means occasionally forgetting about diabetes.

On Labor Day my son invited my husband and me to join him for 18 holes of golf at his home course. He plays at Hazeltine National Golf Club which is near his home in a western suburb of Minneapolis. Hazeltine is a championship venue which has hosted events such as the U.S. Open and the PGA Championship and will be the site of the Ryder Cup in 2016. The first question you should ask is  “Why in the world is a hacker like me playing a course like that?” The answer is “Because I can and because my son invited me!” I play from the ladies tees which are a mile ahead of the championship tees and amazingly I don’t score that much higher than on my home course. I also decided a long time ago that I should have fun playing golf whether I shoot a good round or not. For the most part I succeed at that.

What I have never mastered at this course is diabetes. Hazeltine is a long and hard course for me to walk. I’ve played there twice and both times have played after lunch which is not my “normal” golf time. I’ve never needed paramedics there, so why am I complaining? When I walked up the 9th hole on Monday feeling incredibly low and having already finished one 10-count roll of glucose tabs, I had a flashback to last year when at the same point on the course I was exhausted and desperately low. (I’ve only played Hazeltine twice. I am not like my husband who can remember every round of golf he has played in the last 50 years. But I am someone with diabetes who can remember every severe low BG since 1976.)

Neither this year nor last did I complain to anyone. Both times I was able to keep playing using the reserve glucose tabs and snacks that I keep in my golf bag. I know that I should tell my husband when I am low, but I’m too stupid tough for that.

But this year was very different from last year. As I walked up the 9th fairway, I was mentally devastated with how sad I was and how lonely my diabetes is. What would it be like to play golf or hike or do anything and not experience low blood sugar? Why is my life a constant math equation with seemingly no reliable solution? Why do I have to deal with this and no one else does? Why can’t I figure it out? Why does it have to be so hard?

Why? Because it is hard. TYPE 1 DIABETES IS HARD. I know that and so do you.

There I’ve said it and I’ll say it again. TYPE 1 DIABETES IS HARD. Now I will quit whining and return to the previously scheduled program of Pollyanna….

Pollyanna

On Tuesday of this week Riva Greenberg of The Huffington Post shared her experiences with the hidden difficulties and loneliness of living with Type 1 diabetes. If you haven’t read this article, please check it out: The Invisibility of Type 1 Diabetes. Riva and I are close in age and she has had Type 1 for 43 years compared to my 39 years. Riva is usually upbeat about living with diabetes and her post is an insightful peek at what goes through Pollyanna’s mind when the “Glad Game” just isn’t enough to keep her smiling amidst the highs and lows of diabetes.

Can Advocacy Take a Vacation?

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Laddie_Head SquareI haven’t been writing much these days. I was definitely burned out after Diabetes Blog Week but was on the exit ramp before that. I began blogging 2+ years ago and although I am proud of what I have shared about my life with Type 1 and my opinions about diabetes issues, I am starting to feel that I have just about said it all. I am definitely tired of the work of writing and creating graphics for my posts. At the same time I don’t think that I am ready to quit. In my first post for Test Guess and Go, I wrote:

The medical system in the United States is changing and I really wonder what the next years will bring for those of us with diabetes….  And before I know it, I will be on Medicare with a new set of rules that will save me lots of money in some areas, but will try to dictate that I live with 3 test strips a day and throw away my CGM because it is not proven technology.

Nothing in that statement has changed since 2013. My Medicare worries used to be about lack of CGM coverage. In mid-2015 I know people with diabetes on Medicare who are no longer able to obtain test strips for name-brand BG meters. I know several women with Type 1 who have had difficulty getting pump supplies on a timely basis. Finding a provider for Part B insulin for pumps continues to be a common difficulty.

Today I am about 20 months away from the transition to Medicare. It is too soon to evaluate my choices about Supplemental and Advantage plans. It is too soon to start hoarding Dexcom sensors and Freestyle test strips because of limited expiration dates. I am trying to purchase pump supplies on a timely basis, but it seems unwise to stock too many supplies because I will be buying a new pump in the fall of 2016.

My hope is to hang on as an active blogger in order to chronicle the journey of moving from a lifetime of excellent private insurance to the scary unknowns of Medicare. I am proud of what has been accomplished at Test Guess and Go by my writing and that of Sue from Pennsylvania and Sue from New York. I don’t want to see Test Guess and Go fade into oblivion.

Lately I have felt guilty that by not writing and actively engaging in diabetes social media that I am not doing “my job.” I am failing in my public persona as a diabetes advocate. I know that I am being too hard on myself and that starting a blog is not a life contract to do it forever.

Advocacy things that I have done in 2015:

I have followed through with every email from JDRF urging me to contact my elected representatives on diabetes-centric legislation. I participated in the campaign for the Special Diabetes Program which was successfully renewed for two years in April with $150 million allocated for diabetes research.

I have contacted my Senators and House Representative to support S. 804: Medicare CGM Access Act of 2015 and H.R. 1427: Medicare CGM Access Act of 2015. Like many people I have been frustrated that this is the 3rd generation of these bills and they are still rated by GovTrack as having 0-1% chance of being enacted. Even if you contacted your elected representatives for the 2013 and 2014 bills, please do it again for the bills of the current legislative session. Remember that Medicare policy trickles down to all insurance and even if you are not age 65, this coverage is crucial for people of all ages with diabetes. It is super easy to do if you go to the JDRF CGM Coverage by Medicare page.

I have joined DPAC (Diabetes Patient Advocacy Coalition). DPAC was co-founded by Bennet Dunlap and Christel Marchand Aprigliano. The purpose of the organization is to unify and streamline diabetes advocacy and make it easy for each one of us to have our voice heard by U.S. decision makers. If you are not yet a member of this group, please read this blogpost by Christel at theperfectD and this post by Sue at Diabetes Ramblings. Then follow the links to join DPAC.

I was fairly active through the first half of 2015 and advocated for DOC programs such as Spare a Rose, Save a Child. I attended the Unconference and generally immersed myself in diabetes stuff.

After writing but not publishing this post, I wrote a blogpost to my daughters-in-law urging them to learn the symptoms of Type 1 diabetes and share the stories of Kycie and David, two young children who recently lost their lives as a result of Type 1 diabetes.

Advocacy things that I have not done in 2015:

I have rarely used my blog to educate and encourage others to advocate for important diabetes issues.

I have continued to read every blog in my blogroll, but in recent months I have left few comments and feel bad about that. Many times I have started a comment and then deleted it after becoming lazy and paralyzed in my thoughts halfway through.

I have been mostly absent from Twitter and #DSMA and #DCDE TweetChats. Obviously it’s not a requirement to participate in things like this, but it is a sign of support to others in the DOC. In general I am not a huge Twitter person and I may start using my age as an excuse to maintain a minimal Twitter presence.

I stayed on the sidelines for the CrossFit issue. On one hand that is good because I didn’t say something stupid and insensitive. On the other hand, I didn’t rush to support the heartfelt posts of my Type 2 friends including Kate Cornell, Sue Rericha and Bea Sparks. A “Like” on Facebook isn’t a sufficient response to seeing wounds of blame, shame, and anger re-opened in the diabetes community.

Moving forward?

For now I am on summer vacation. I’m not mad or sad. You don’t need to comment and tell me how wonderful I am or give me permission to be a bum. I’m just tired of writing and being overly immersed in diabetes social media and I don’t want to feel guilty about that.Vacation Beach I’m still reading blogs and keeping up with Facebook. I’m supporting my friends doing runs and bike rides to raise money for diabetes. I’m still here and for better or worse, I still have diabetes.

Fortunately my blogging malaise has not been accompanied by personal burn-out. My diabetes is difficult these days, but I get up every morning with the optimism that I’ll do better today than yesterday with blood sugars. I’ve ordered a mysugr T-shirt and will wear it proudly while battling my D-monster “Glukomutant.” I’ve been walking a ton (#Fitbit) and working with a personal trainer. I’ve cleaned closets, played golf, read a lot of books, and done some much-needed yard work. I’ve been super-Grandma and spent a lot of time with my four grandchildren.

I have many things to write about, but I don’t want to write. Maybe by giving myself permission to not write, I’ll feel free to start writing again. Maybe. Maybe not. This is not a good-bye, au revoir, adios, or sayonara post. I kind of think of it as:

See you later, alligator. In a while, crocodile.

To My Daughters-in-law

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Laddie_Head SquareDear Becky and Danielle,

You have never known me without Type 1 diabetes because I was diagnosed before you were born and certainly before you married my sons. You may have seen me test my blood sugar and push buttons on my pump to take an insulin dose. You have never seen me incapacitated or ill as a result of diabetes and it is possible that you come away from my story without understanding how serious and deadly Type 1 diabetes can be. Very naively I never worried that your husbands/my sons would get Type 1 and so far they haven’t. I pray that your children/my grandchildren never get diabetes, but if they do, you will manage and they will be fine.

Today I have information that I want you to share with you. Last weekend, two young children died because of Type 1 Diabetes. These were not children without access to medical care. They could have been your child or your neighbor’s child. One of these children was incorrectly diagnosed by her doctor. A simple blood test with a $1 test strip or a urine dipstick test could have diagnosed Type 1 diabetes in 5 seconds and saved her life. The second child was diagnosed correctly in the emergency room. Despite state-of-the-art medical care, he died a few days later.

Five-year old Kycie became ill one Sunday in late January, 2015. Initially her parents thought she had the flu and a Wednesday visit to the child’s doctor resulted in antibiotics for strep throat. She went to the doctor again on Friday and to the ER that afternoon. A series of seizures resulted in extensive brain damage. Tens of thousands of people followed Kycie’s story on Facebook as she and her family battled for 6 months to save her life. On Saturday, July 11, Kycie passed away at home in the arms of her parents.

A shorter story, but just as heartbreaking, is that of David Michael Brown who died in a pediatric ICU at age four last Sunday, July 12. David became ill midweek with what appeared to be the flu. When his symptoms became more severe, his parents took him to the ER where he was correctly diagnosed with Type 1 diabetes. Intensive medical care could not save his life and within a few days, David lost his battle with diabetic ketoacidosis as a result of multiple organ failure.

I urge you to learn the symptoms of Type 1 diabetes as shown in the poster below and explore the Test One Drop website. I also suggest that you like the Test One Drop Facebook page. The mission of this organization is to

“bring awareness to the general public and the medical community of the similarities between the symptoms of Type 1 Diabetes (T1D) and common illnesses such as influenza, strep, and viral infections with the purpose of stopping delayed and misdiagnosed T1D which can lead to life-threatening DKA, permanent handicap, or death. Additionally, we are seeking a change in the Standard of Care Practices to require medical personnel to screen blood or urine samples for glucose levels before diagnosing sick patients with a common illness that might be masking or mimicking Type 1 Diabetes.”

t1d-educational-8-5x11_New

My wonderful daughters-in-law — although your children are at a somewhat higher risk of getting Type 1 diabetes because of my diabetes, most diagnoses are of children and adults with no family history. The causes of the autoimmune beta cell destruction resulting in Type 1 diabetes are not known. For unknown reasons the incidence of Type 1 is increasing worldwide. Although this post highlights the stories of two children, please remember that Type 1 diabetes can strike at any age from infants to senior citizens and these symptoms should not be ignored in adults.

Share this message with your friends, family, and acquaintances. Educate your schools and daycare. Print out the free poster from the Test One Drop website and ask your pediatrician whether they test the blood sugar of children at well-child visits and whenever they have flu-like symptoms.

Although there is nothing easy about living with Type 1 diabetes, I am one of many people who illustrates that you can have a wonderful life with and despite diabetes. You, my sons, and your children are proof of that.

Throughout my 38 years of Type 1, I have seen incredible improvements in insulin and technology that make living with this condition more manageable. Two things have not changed. Type 1 diabetes is a death sentence if it is not diagnosed. And even with proper medical care, Type 1 diabetes is a serious and life-threatening illness.

With love as always,

Laddie, your Mother-in-law

Please note that this blogpost was edited in November 2015 to reflect a correction in David Michael Brown’s story. My understanding from Facebook stories in July was that an incorrect diagnosis had led to a delay in care for David. That was not the case and he was diagnosed correctly. But even with appropriate and intensive medical care, David lost his life as a result of Type 1 diabetes.

I have also updated the Test One Drop mission statement and displayed the current version of the free downloadable poster.

NuGo Nutrition Slim Bars: As Good as Advertised?

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Laddie_Head SquareI don’t do many product reviews. Most of you don’t want to read them and I don’t use many of the product types that are pitched to me. In general I am quick to share my strong opinions about the pumps, CGM’s, and meters that I use and I am comfortable with my stance of not reviewing products just for the sake of getting something free.

In mid-May I received an email from a marketing rep at NuGo Nutrition. She wrote that NuGo Slim “is a delicious snack to help effectively manage blood sugar levels. It has been tested and proven to be the lowest Glycemic Index protein bar on the market with a GI score of 24! It’s also gluten-free, non-GMO, contains no maltitol….” Blah, blah, blah. Usually that is not enough to impress me. What hooked me was: “is coated with REAL dark chocolate.”

Nutrition bars have never been part of my life although I carry Nature Valley Crunchy granola bars when I hike. I rarely eat them but pack them because they are full of sugar, taste good, and hold up well in the heat.  Although I hike long distances (10-13 miles), I have never once sampled a Cliff bar, a Kind bar, or any other high-protein bar. In general I have my steadiest blood sugars when I use temporary basals and don’t eat. Obviously on an all-day hike I need food and do my best to bolus correctly for a cheese sandwich and an apple at lunch. Frankly I have no idea whether there would be a benefit of adding low-glycemic high-protein bars to my trail food. Maybe there would be.

So I said yes to the NuGo promotion and received a large box that included the five flavors of NuGo Slim bars. I told my husband that he was allowed to eat them but he must leave a note with a taste review. He started with the Espresso bar and indicated it tasted good but was a bit dry. My first sample was Brownie Crunch bar (the more chocolate the better!) and I thought it was quite good. Both of us liked the other bars. After Brownie Crunch, my favorite was Roasted Peanut. The Raspberry Truffle was tasty and a good texture, but I personally like my chocolate without other flavors. The dark chocolate coating on all of the bars was delicious and definitely tasted like “REAL dark chocolate.”Sample Pack 2

So how did they work with blood sugar? The first time I monitored my BG, I subtracted the 7 grams of Fiber and bolused for 12 grams of carb. Amazingly I did not get a huge spike and my BG reading at 1 hour was level. At 2 hours however, my BG had climbed about 35 points. I will need more bars to keep the experiment going, but I think the best bolus profile for me might be to pre-bolus for 12 grams of carb and then use an extended bolus of 1 hour for the additional 7 grams. (Somehow subtracting out fiber has never worked great for me.) But I definitely did not get the huge spike that I would have seen with a traditional brownie.

One plus was that the “heavy” texture of the bars helped me be satisfied with just one bar.  With regular brownies and cookies, one bite usually makes me crave more and I rarely never stop at one bar or cookie. So are these bars a good choice to satisfy my sweet tooth without totally wrecking my blood sugar? Maybe. Am I better off continuing to try (not always successfully) to avoid most sweets? Maybe. But I decided to invest in another box of Slim bars to see if they make sense as a long-lasting addition to my diet. I’ll definitely be interested in my blood sugar patterns as I try more bars.

Although NuGo Nutrition Slim bars are available in many markets, I did not have much luck finding them locally. My closest “premium” grocery store does not stock them. A nearby Whole Foods carries the regular bars, but not the Slim variety. I was in Annapolis, MD last week and the Whole Foods there did carry two Slim flavors as did Fresh Market. Fortunately the Where to Buy tab on the NuGo website indicates which varieties of bars are carried at each store.

Today I ordered a 12-pack box of Slim Brownie Crunch bars online. The cheapest option I found was at iHerb.com where the price was $20.86 for a box of 12. I received a $5 credit for my first order and then paid $4 shipping. The final cost was $19.86 or $1.66 per bar. (Amazon was much higher.) A box of 12 is available on the NuGo website for $21 + $5.95 shipping ($100 order required for free shipping).

Are the NuGo Nutrition Slim bars as good as advertised? Actually I think that their claims are credible and if you are looking for a “blood sugar-friendly” nutrition bar, you should check out the NuGo website. All Slim bars are certified to be Gluten-free and 2 of the flavors are Vegan. Detailed nutrition information is available here by clicking on each flavor of bar. If you’d like to read another review of NuGo bars and diabetes, check out Tarra’s review at My Crazy Life With My Diabetic Service Dog.

*****

I received a complimentary sample box of NuGo Nutrition Slim bars, but as always, my opinions are my own and not available for sale.

Continuing Connections: Pray for Caleb

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6th Annual Diabetes Blog WeekToday’s Topic:  The very first inspiration for Diabetes Blog Week was to help connect our blogging community, and that continues to be the most important reason it’s held every year.  So let’s help foster and continue those connections as we wrap up another Dblog Week.  Share a link to a new blog you’ve found or a new friend you’ve made.  Or pick a random blog off of the Participant’s List, check it out and share it with us.  Let’s take some time today to make new friends. To read other posts on this topic, click here.

Laddie_Head SquareI have met a lot of new people during the 2015 Diabetes Blog Week. I have added your blogs to my bookmarks and to my Feedly Reader content list. For sure if you keep writing, I will keep reading. I am going to briefly mention three blogs that I particularly enjoyed this week, all for different reasons. And then I am going to highlight one blogger from last year whom I believe all of you need to know about.

Completely new to me:  One new-to-me and relatively new-to-blogging writer whom I enjoyed getting to know this week is Frank of Type 1 Writes. Frank is a young man from Perth, Western Australia who is passionate about writing and even more passionate about diabetes advocacy. I think we will see a lot more of him in future years.

Not new to me but his blog is:  Brian (BSC) is super active at TuDiabetes and I have read his message board contributions for years. I was also pleased to meet him in person at the Diabetes Unconference in March. I didn’t know that he had a blog: The Trials of Type 2 Diabetes. To say Brian is a “know-it-all” is to trivialize his research and knowledge about diabetes, especially Type 2. I look forward to both reading his blog and using it as a resource to learn more about all kinds of diabetes.

New to me but not to the DOC:  When I read Marie Smith’s posts this week, I was blown away by her writing. Then I was blown away by her story. In addition to having diabetes, Marie lives with myasthenia gravis, has survived cancer, and deals with severe pain. Her writing acknowledges that pain but celebrates and affirms life. I will follow her blog Joy Benchmarks and have already started to read the first of her two books. Marie has been blogging for much longer than I have, so we have mostly just hung out in different corners of the DOC. But then I figured out we were following each other on Twitter (@cellobard).

What you all need to know when it comes to our diabetes community:  Last year during Diabetes Blog Week, I met a young blogger named Caleb. He was a well-spoken high schooler who was documenting his diabetes life interwoven with the stories of his two siblings who also have Type 1. Definitely wise beyond his years…. Fast forward to April of this year when Caleb saw a doctor for evaluation of severe shoulder pain. A mass was found and he is now facing an epic battle against Ewing’s Sarcoma. Ewing’s Sarcoma is an aggressive bone cancer that affects mainly children and adolescents.

Caleb needs the support and prayers of everyone in the diabetes online community. His blog is Type One Trio and there are occasional updates from Caleb and his family. Caleb is reassured that he will have the strength he needs because he is a Child of God. He recently quoted scripture that is giving him strength as he begins a battle that no one should have to face. Caleb is a child of our diabetes community and regardless of your religious beliefs, please pray for him.

“Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort;

Who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble, by the comfort wherewith we ourselves are comforted of God. 

 For as the sufferings of Christ abound in us, so our consolation also aboundeth by Christ.”

 II Corinthians 1:3-5Type One Trio

My Most Favorite Ever

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6th Annual Diabetes Blog WeekToday’s Topic:  If you have been blogging for a while, what is your favorite sentence or blogpost that you have ever written?  Is it diabetes related or just life related?  If you are a new blogger and don’t have a favorite yet, tell us what motivated you to start sharing your story by writing a blog?  (Thank you Laddie of Test Guess and Go for suggesting this topic.) To read other posts on this topic, click here.

You probably noticed above that today’s topic was my!!! idea in response to Karen Graffeo’s request for help. I selfishly suggested this topic because I have a favorite sentence that I always read with astonishment that I wrote such a beautiful thought. The sentence has nothing to do with diabetes but it is part of a blogpost that celebrates all types of diabetes, dogs, cats, and DOC friends.

But look at me taking credit for this sentence! It was actually written by Abby the Black Lab whom many of you know as a guest author for Test Guess and Go. Abby is quite popular and her posts get more readership than mine. Basically who doesn’t like dogs more than diabetes? My favorite blogging sentence is part of my favorite post and was written by Abby. The sentence follows and you probably need to read the whole post to put it in context:

“It is a magical glimpse of heaven for a lucky black dog who is showered with love by a beautiful princess gray cat.”

The entire post as reprinted from 9/09/2013 follows:

The Great Divide in the DOC

Abby with Abby Crown_no backgroundI’m Abby the Black Lab and it has been a while since I have written a blog post.  Lately I have been utterly distressed by a great divide that I see in the DOC (Diabetes Online Community) and I think it is time to bring this to the attention of my readers.  You probably think I’m going to start talking about the Type 1 versus Type 2 wars that periodically surface on the Internet.  Are you kidding?  My subject is not nearly as trite as that.

No, it’s the dog people versus the cat people.  The canines versus the felines.  The lovable, loyal, goofy, tail-wagging dogs versus the slinky, aloof, meowing and menacing kitty cats.

The cat aficionados have long been led by Kerri from Six Until Me whose cat Siah is a media star who poses in laundry baskets and attempts to dominate the DOC as an “internet celeb-kitty.”  The dog people are more decentralized in their leadership.  Canines have conceded Twitter to the cats, but think that we rule Facebook.  The blogosphere is probably a toss-up, but my opinion is that dogs are truly superior in their contribution to their PWDs (people with diabetes).  Duchess is a diabetes service dog who daily keeps her owner Tarra safe.  Meri’s boys are protected from the abyss of low blood sugars by Lawton the Yellow Lab.  All human hearts have melted seeing photos of Kim’s corgi watching over the new baby “Rabbit.”  Black labs like Riley owned by Mike Hoskins insist that their owners exercise by taking them for daily walks.

Cats meanwhile are tiptoeing across keyboards and writing meaningless blog posts with the tag line “zxzxzxdjjj.”  Pissed-off and non-sleeping kitties are considered newsworthy.  Oh yeah, Chris of @iam_spartacus fame has some feisty looking cats and @KarenBittrSweet claims to have the world’s cutest cat.  Videos of Grumpy Cat are ubiquitous, but if I want to see grumpy, I can look at my owner Laddie when her meter says 286.

Fortunately the DOC universe of cats and dogs has recently been in a state of equilibrium with only a few ripples of discord.  The dog people tried to sneak one under the rug in Twitter and Facebook with the purchase of a Scottish Terrier named Bella by Cherise.  Someone needs to tell Bella that if she wants to become an icon in the DOC Canine Hall of Fame, she should learn to walk on a leash.  Also tell her that if she’s going to be a supporter of people with diabetes, lancet devices should not be on the menu.  The cat people have lost some heroes as Kerri and Pancreassasin mourn their beloved friends who have gone to the scratching post in the sky. (RIP Prussia July/2013 and Pancreassasin 2week kitty August/2013).

But the calm has been shattered!  Earlier this month the cat people added a new Abby_Loopy2superhero to their roster in the guise of a young child named Birdie.  Smiles and cute Batman Princess costumes are not adequate to camouflage the chaotic schemes of this young and seemingly innocent feline-loving child.  With no attempts to disguise her evil intent, this child suggested that the family cat Siah was lonely and needed a friend called…. Loopy.

The Loopy hullabaloo has not been all.  Another scandal has been exposed in the DOC and I, Abby, a supporter of all people with diabetes, have been accused of consorting with the enemy.  A photo of a certain black lab being nuzzled by a gray feline has been splashed across the headlines.  I confess.  I am guilty.  I like cats and cats like me.

Abby Headlines

Every year I put “Kitten” at the top of my Christmas list.  Unfortunately my owner Laddie is allergic to cats, so no personal kitty is in my future.  I am extremely fortunate that when Laddie travels, I get to go to Linda’s house and visit my friend Nikki.  Nikki is a shy cat, but I have learned to approach her slowly and lay my head down acknowledging that cats are supreme.  She rewards me with purrs and caresses of her head against mine.  It is a magical glimpse of heaven for a lucky black dog who is showered with love by a beautiful princess gray cat.

My romance with Nikki has some important lessons for everyone.  Although you seemingly-civilized people with Type 1 diabetes sometimes argue with those who have Type 2 diabetes, you pancreatically-challenged doofuses should remember that you are stronger together than apart.  Diabetes in all of its evil forms is the enemy and you should join hands and conquer it together.

More importantly, we dogs and cats should toss aside our petty differences and stop the harassing hisses and barks.  With a united army of canines and felines, we can fight a cosmic battle against our common enemy.   A enemy who taunts and teases us in our own yards and through our own windows.  An adversary who seems to think that dominance is achieved through water-skiing videos.  We have seen the enemy and the enemy is……..SQUIRRELS!

Abby Crown Against Squirrels

Other Posts by Abby the Black Lab

Abby the Black Lab Discusses DSMA Live

Abby the Black Lab Discusses Nutrition

A Diabetes Poem by Abby the Black Lab

Abby the Black Lab Discusses Community

Zoodles, Vegetti, and Sweet Patoodles

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6th Annual Diabetes Blog Week

Today’s Topic:  Taking a cue from Adam Brown’s recent post, write a post documenting what you eat in a day!  Feel free to add links to recommended recipes/shops/whatever.  Make it an ideal day or a come-as-you-are day – no judgments either way.  (Thank you, Katy of  Bigfoot Child Have Diabetes for this topic.) To see other posts in this category, click here.

Laddie_Head SquareHere we are on Day 5 of 2015 Diabetes Blog Week. More than once this week I have strayed from the topic at hand and today is another one of those days. Rather than outline what I eat in a day, I am going to share one of my favorite cooking gadgets and highlight the most beautiful salad that I have ever made. Katy who submitted this topic won’t be mad at me because if she doesn’t already have a spiralizer, she will after she learns about zoodles and sees my beautiful salad.

Earlier this year on Facebook, my D-buddy Kate Cornell talked about fixing zoodles for dinner. I am not a very inspired cook, but this discussion interested me. Like what in the heck is a zoodle? Whenever I read what Kate is cooking, I always wish that her delicious low carb meals could beam through the Internet and land on my table. Unfortunately that hasn’t happened yet…

I was sufficiently intrigued with zoodles to find out from Kate that they are zucchini noodles that are made using a gadget called a spiralizer. Zoodles cook quickly and are an amazingly good substitute for noodles for those who want to eat low carb, increase the quantity of vegetables in their diet, or eat gluten-free. I asked Kate what brand of spiralizer she owns and ordered the same one (Gefu) from Amazon.

My spiralizer arrived and I spiralized zucchini (zoodles) and yellow squash (squoodles?) for dinner several times. They were delicious and so easy to prepare. Amazingly I have not yet served my zoodles with pasta sauce, but I will soon.

In early April I was having a friend over for supper and decided that I wanted to use my spiralizer to make either soup or a salad. I looked at photos online and found the most gorgeous vegan salad. You can find the photo and recipe here.Vegan Salad that

I do not follow a vegan diet and it is probably a sacrilege that I used this salad as a model for my chicken salad plate. But I did and I thought the result was great. (The other non-vegan part of the salad besides the chicken and probably the mayonnaise was that I used feta cheese instead of tofu.) Later on in April I had more friends over for dinner and once again plated the salad. I was universally complimented for the dinner and it was a great low-carb meal for me. I served bread both times with the salad and that is why the left side of the plate is empty in the photo.

My Salad with Spiralized

Since then I have purchased a spiralizer cookbook called Inspiralized by Ali Maffucci. Ironically she learned about the spiralizer from her mother who has Type 1 diabetes. I also follow Maffucci’s blog. You can also Google spiralizer recipes and find great meal ideas.

The Gefu spiralizer is fine and I left it at my Arizona house. I have just ordered a new spiralizer for Minnesota and decided to buy one with more blades because Maffucci talks about blades 1-4 in her recipes and the Gefu has only 2. You can find spiralizers priced from about $15 to $50. I am not experienced enough to provide any advice.

Random spiralizer fact:  According to Maffucci, one of her readers sent in a video with her child jumping rope with a zoodle.

Another fact: You can also use a spiralizer to make “rice” from vegetables or even spiraled buns.

Final fact: If I can do this, anyone can.

My Blue Ribbon First Place Change

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6th Annual Diabetes Blog Week

Today’s Topic:  Today let’s talk about changes, in one or two ways.  Either tell us what you’d most like to see changed about diabetes, in any way.  This can be management tools, devices, medications, people’s perceptions, your own feelings – anything at all that you feel could use changing.  OR reflect back on some changes you or your loved one have seen or been through since being diagnosed with diabetes.  Were they expected or did they surprise you? To read all of the other posts in this category, click here.

Laddie_Head SquareHaving been diagnosed with diabetes in 1976, I have experienced a huge number of changes. Some, such as the advent of home blood glucose meters, were so long ago that I don’t remember the effect on me or my diabetes care. Others, such as my insulin pump, greatly increased my quality of life but didn’t improve my A1c.

By far the biggest improvement in my diabetes care as tracked by the change in my A1c and maybe in the stability of my blood sugars was the addition of Lantus to my diabetes regimen. Those of you who were diagnosed after the days of NPH missed out on the rollercoaster peaks and valleys of this “Not Particularly Helpful” insulin. There were definite benefits to NPH such as rarely needing a shot for lunch and getting to eat bolus-free candy bars at 4:30 PM in order to make it to dinner without a paramedic visit. But it was an intermediate-acting insulin that was slow to start working and then hit with a vengeance 6-9 hours after injection. The most difficult thing about NPH was its unpredictable variability from day to day.

Lantus was introduced in the United States in May 2001. At that point I was seeing an endocrinologist whom I liked a lot and was/still is quite renown in the world of diabetes. I remember one of my last appointments with him. He looked at my A1c and BG records (using a regimen of NPH, Regular, and Humalog insulins) and said something like: “You’re doing great and seem to be able to get anything to work. Keep doing what you’re doing and let’s not make any changes.” Soon after this appointment I left this endo’s practice for insurance reasons and switched to an internal medicine doctor as required for an endocrinology referral in my new network. At my first appointment with the Lantus First Placenew doctor, he looked at my medications and said something like: “Why in the world are you still on NPH and not taking Lantus?” I was far from a proactive patient in those days and probably had never heard of Lantus.

I started on Lantus immediately and four months later, my A1c had dropped 1.7 points from my test 5 months earlier. Even more amazingly, my A1c was 2.5 points lower than the test of 9 months previous. I had also lost the ten pounds that I had gained in my perimenopause 40’s. So much for an endocrinologist versus an internal medicine doctor…. I got some of my best diabetes care ever from this internal medicine doctor and did not return to an endocrinologist until several years later when I chose to begin using an insulin pump.

Lantus is not perfect by any means and these days many Type 1’s take two to three injections a day rather than the 2001 “promised land” of one injection a day. I am a very happy pumper in 2015 but know that if I had to go back to a regimen of Lantus/Levemir and Novolog/Humalog/Apidra, I would be totally fine. The major change would be that I would have to become comfortable injecting mealtime insulin in front of other people and probably take several injections of Lantus/Levemir per day.

I have decided to negotiate with Medicare who will be my insurer in 23 months. If Medicare will fund my Dexcom CGM, I promise to go back to injections and probably save the insurer money. Unfortunately under current regulations, that idea is a pipe dream and I will continue to pump and save my pennies to personally fund my Dexcom.

One thing that I will not do is to go back to NPH. Unless that is my only choice….