Playing Roulette with the TSA

Posted on July 18, 2013 by Laddie

There are a couple of certainties in my life. If I want to travel, I need to fly. If I fly, I need to go to the airport. If I want to get to my airplane, I must go through a TSA security checkpoint. Sounds pretty simple, doesn’t it?

Like most people who travel with an insulin pump, my stress level rises as I approach the TSA checkpoint. My normal strategy is to stick my pump inside my waistband and wear a shirt long enough to hide it from view. If I see that I will be screened with a traditional metal detector, I rejoice because I have a good chance of walking through it without alarms and therefore no pat-down. Occasionally I set off the alarm and I’ve never been able to figure out why sometimes it alarms and usually it doesn’t.

If I see an advanced imaging technology scanner, I know it is a certainty that I will have to declare my pump and receive a pat-down. Some TSA personnel will tell you that you can wear your pump through the scanner, but I choose to follow the directive of my pump company that the pump should not go through the scanner.

I hate pat-downs and feel somewhat violated by them. I have been lucky that every pat-down agent has always treated me politely and I do my best to relax knowing it will be over soon. I live in total fear of having the horrible TSA experience that fellow Type 1 Kelly Kunik experienced in April of this year.

I once flunked the swabbing of my hands and that resulted in a search of my carry-on luggage as well as an extensive pat-down in a private area. Oops, I mean an area behind a partition although I think they also searched my private areas. Rumor has it that hand lotion can cause a false positive, so I try to remember to never use it before traveling. Kelly Kunik thought that soap might have been the culprit in her swab test.

Basically the TSA experience is a crapshoot. It’s a roulette game where you spin the wheel and what you get is what your get. Earlier this year there was an online petition urging for consistency in screening of people with diabetes. I have read that the TSA values inconsistency and I think it is unlikely that we will see much change.

My husband travels frequently and qualifies for TSA PreCheck. This is a program that according to Delta’s website is “an intelligence-driven, risk-based screening initiative through which eligible passengers are selected for expedited screening.” He goes through a special line at Delta checkpoints and walks through without removing his shoes, belt, or liquids and computer from his briefcase. It seems to me that there could be a program where people with medical devices, artificial joints, etc. could pre-register in some program that would help us move through security in an easier and more predictable way.

Every time I am selected for additional screening, I marvel at our security system where senior citizens in wheelchairs or with artificial joints and people with insulin pumps are being pulled aside every time that we travel. At the same time I read of people who have gotten guns and knives through the checkpoints. Not to say that a granny can’t be a terrorist, but in general, someone is wasting resources here.

I’ll be traveling later this week. Time to play roulette with the TSA!

Abby the Black Lab Discusses Nutrition

Posted on July 15, 2013 by Laddie

WHILE THERE IS NO SUCH THING AS A PERFECT DIABETES DIET, THERE ARE CERTAIN GUIDELINES TO KEEP IN MIND TO ENSURE HEALTHY EATING WITH DIABETES. TODAY ABBY THE BLACK LAB HAS TAKEN TIME TO ILLUSTRATE SOME IMPORTANT NUTRITION POINTS. PLEASE NOTE THAT HER ADVICE MIGHT DIFFER SLIGHTLY FROM WHAT YOUR NUTRITIONIST TOLD YOU.

Although I do not have diabetes, I know a lot about food. Like most Labrador Retrievers, food is my hobby. Food is my passion. Food is my inspiration for excellence. I think about it most of the time when I am not out shopping for new sunglasses and other fashion accessories. Today I will share some guidelines that I am sure will help in your daily attempts to eat nutritiously while enjoying every bite of food and meeting your blood sugar goals.

If you have any questions about nutrition, please do not hesitate to leave a comment or send an email. As always your friend, Abby the Black Lab.

Blah Blah Blah

Posted on July 11, 2013 by Laddie

I think that most of the Type 1 Diabetes Online Community is currently in Lake Buena Vista, Florida for the 2013 Friends for Life Conference.

I know that when I write a blog post, it should be meaningful to me regardless of whether anyone else reads it.

But I know that everyone is in Florida and no one is going to read this. So blah, blah, blah.

A year ago I would have thought that there was nothing for me at the FFL conference. But now I think that maybe I should go next year.

Blah, blah, blah.

OmniPod’s New PDM

Posted on July 8, 2013 by Sue from New York

I had anxiously waited for several months to get my new OmniPod PDM and smaller pods. When they finally arrived I was very excited, but decided to finish using the old pods before starting the new ones. On the advice of a friend I did save one pod in case something happens to the new PDM, so I can use it with the old PDM before a new PDM replacement arrives.

I started using my new PDM and pods five days ago. During the setup, I was instructed to put in my ID Name, so I put in Sue. Now every time I turn on my PDM, including when I insert a test strip for a blood sugar check, I see this screen:

PDM ID:

Sue

Press “Confirm” if correct.

I wondered what could possibly be the reason for this extra step before using the PDM? Have there been people using the previous PDM who used someone else’s PDM by mistake? Shouldn’t they give us a way to shut this feature off if we so desire? My son, who also has type 1 diabetes, lived with us until 3 months ago. He uses the Medtronic pump, but if he used the OmniPod pump, we would have used different colored gel skins to differentiate them. That would have been easy enough to do, because I have four gel skins-two white, a lime green and my new black one that came with my new PDM.

Now I’m the only one in the house who has diabetes, so there is zero chance of someone else here wanting to inject insulin. So I decided to call Insulet Customer Support and ask if there was a way to turn this feature off. I was told that no, there is no way to turn it off (in other words, suck it up). I asked the reason for this feature, and was told that there are some families with more than one person with diabetes using the OmniPod PDM, and they added this feature to eliminate confusion. I guess it never occurred to them to tell those people to use different colored gel skins on their PDMs.

OK I’m trainable, and I’ll get used to this extra step, but it still seems silly to me. But on second thought, since this pump is not attached to the body like the conventional pumps, I suppose they are trying to eliminate any chance of being sued. I sure hope no one has already tried to sue them for this, because I do love the company and their new smaller pods and hope they continue to stay in business until there is a cure for diabetes, quirky PDM and all.

Strip Safely: Join the Campaign

Posted on July 5, 2013 by Laddie

Like many people with diabetes, I am frustrated by inaccurate readings from my blood glucose meters. The FDA requires that 95% of our meter readings above 75 mg/dl be within +/- 20% of the actual blood glucose value. Below 75 mg/dl 95% of the readings must be within +/- 15 points of the actual value. That means that my meter reading of 200 could actually be 160 or 240 and be considered accurate. Or my 60 could be a 45 or 75. When you base your insulin doses on these numbers, it’s a scary proposition.

I have learned from the Strip Safely website that the FDA standards are only part of the problem. Currently there is no further testing by the FDA once a meter and strips are on the market. At the Diabetes Technology Society’s May conference, studies were presented showing that there are many BG systems on the market that do not meet current standards and that some are as much as 40% high or low. That 200 meter reading can now be anything from 120-280. Most of the non-compliant meters and strips are manufactured outside the USA and the FDA has trouble monitoring these companies.

It was suggested at this meeting that the CMS (Centers for Medicare & Medicaid Services) bidding process is creating an atmosphere where price alone is determining what will be available. Quality is being sacrificed and patients are being put at risk. If you want to see one of those patients at risk, look in the mirror. I am close to Medicare age and I am terrified. Because Medicare standards influence most insurance company decisions, everyone of any age is affected by this.

Bennet Dunlap of the YDMV blog is the driving force behind the Strip Safely campaign. Only Bennet could have thought of such a titillating name:) He is encouraging each of us to visit the website, take the quiz, and learn about the campaign. Then we should follow through and write letters to our senators and representatives as well as members of the FDA. There are instructions about how to do this on the website and many sample letters. If you would like to listen to Bennet discussing the Strip Safely campaign, check out the 7/1/13 DSMA ‘Rents show.

I spent the 4th of July writing letters to my senators, my representative, and the FDA. I can’t think of a better way to have spent our national holiday than by exercising my right to influence my elected representatives. The models for my letters were from the Strip Safely website along with Meri’s letter at Our Diabetic Life. I wrote a longer letter to the FDA and if you would like a copy of it, please contact me through the link in my blog menu. The one page letter to my elected reps is below. This is the first time that I have ever written letters like this. If I can do it, so can you!

My Sample Letter (please copy if you’d like):

I have had Type 1 diabetes since 1976. I use an insulin pump to deliver the exogenous insulin that I cannot live without. I test my blood sugar levels about ten times per day and this testing is a critical part of my diabetes care. I need accurate meters and test strips to enable me to determine the correct amount of insulin required for meals, snacks, and corrections. Inaccurate strips lead to inaccurate insulin dosages that can impact my short-term and long-term health with resulting blood glucose highs and lows. Severe lows can be life-threatening.

The diabetes community in the United States needs your help. Please help keep inaccurate meters out of the hands and off the fingers of people with diabetes. At a recent meeting with the Diabetes Technology Society, the FDA acknowledged that there is a problem with test strips by certain manufacturers not delivering the level of accuracy for which they were approved. Many of these manufacturers are from Asia and other offshore locations. The FDA does not currently have a plan to do anything about the problem.

We need them to have one. Please use your office to help keep Americans with diabetes safe.

Type 1 Diabetes is characterized by incredible variability and inaccurate strips make a difficult disease even more difficult to manage. Please ask the FDA to implement a post-market program of ongoing random sampling of strips to insure that all brands consistently deliver the accuracy in the real world that they were approved to do.

We would also love to see the accuracy standard in the USA tightened to match the ISO standard of 15%. But first things first. Currently a lack of post-market quality control over manufacturers by the FDA degrades the existing standards to irrelevance.

The FDA has many responsibilities. Please make Fixing Diabetes Testing Accuracy one of the things for which the FDA is known.

Very truly yours,

To My Friends and Family

Image

Untethered at the Beach

Posted on July 1, 2013 by Laddie

My summer beach vacation is approaching and I have already started a list of to-do’s, must-haves, and don’t-forgets. Like most people with Type 1, I pack a double or triple supply of pump and CGM accessories, test strips, Novolog insulin, and all of the other paraphernalia needed to care for my diabetes.

I don’t normally keep long-acting insulin (Lantus or Levemir) at home as a back-up for my pump because I feel comfortable with an active and easily-filled prescription at a national chain pharmacy. But when I go on vacation in a remote location or out of the country, I always take syringes and a vial of Lantus with me. I could also take a vacation loaner pump from Animas, but for short trips I don’t bother.

Although my Animas Ping is technically waterproof, I don’t like to wear it in the ocean for fear a rogue wave might rip it off and send it down to Davy Jones’ locker. Even in a pool, I don’t want to deal with the consequences of water intrusion while I’m away from home. Because of the fear of theft, I would never leave my expensive medical device in a cooler on the beach or near the pool. But at the same time, I don’t want to abandon the convenience and precision of my pump for mealtime and correction boluses. And I cannot be without basal insulin for more than an hour without hard-to-correct blood glucose excursions.

My solution for beach and lake vacations is to use the untethered regimen for my insulin. The untethered approach involves taking about 75% of my basal insulin by daily injections of Lantus (or Levemir) and using the pump for the rest of my basal and for most or all of my boluses. The advantage of this is that it allows me to leave my pump safely in my hotel room or lake cabin for hours at a time because most of my basal requirements are being met by the Lantus injection. The advantage of having my pump cover part of my basals is that I can program a bump in my basal rates during the pre-dawn hours. Also, IMO it is better not to suspend the pump for hours on end so I have a pump pattern giving me a constant 25% of my basal needs to supplement my Lantus injection. Some of this basal goes down the drain when I am not wearing the pump, but with my increased activity all day long, I actually don’t need it.

If I am going to have a daylong outing with required boluses of fast-acting insulin, I carry syringes and a vial of Novolog in a Frio case or even more conveniently, take along a Novolog pen. But on this vacation I know that I will be close to the hotel all of the time and won’t need that option.

The best explanation of the untethered regimen can be found in a 2004 article by Steve Edelman. Although I only use this regimen on vacation, there are others who use it every weekend or athletes who use it all of the time.

I was motivated to write this post after reading a 6/27/13 blogpost by Sarah Kaye Sugabetic.me in which she describes how she juggles the use of her Ping pump along with her Omnipod. She states that the Omnipod is great for POOL TIME and I agree that a Pod would be perfect for beach and lake vacations. Unfortunately my insurance company is not going to pay for a second pump system just so that I can swim and snorkel tubeless a few days a year. Sarah has also been spreading the idea of painting her Pods with nail polish and maybe my insurance will approve them because they are a fun fashion accessory in addition to being a life-saving device:)

In the past the untethered regimen has worked well for me on water vacations and I expect the same success this year. It is also a reminder that there are creative ways to increase the flexibility of our diabetes tools by thinking outside the box.

Willpower with Frog and Toad

Posted on June 27, 2013 by Laddie

One of my favorite children’s stories is “Cookies” found in Frog and Toad Together by Arnold Lobel.

The plot follows the two amphibians as they work out how to resist eating a whole batch of cookies baked by Frog. After eating “one last cookie” several times, Frog determines that they need “will power” to stop eating all of the cookies. In reply to Toad’s question about the meaning of will power, Toad says “Will power is trying hard not to do something that you really want to do.” They consider various ways to stop eating the cookies such as putting the cookies in a box tied up with string or putting them on a high shelf. But they are smart enough to figure out that scissors and a ladder can easily overcome those obstacles.

Finally Frog takes the cookies outside and yells for the birds to take them away. When Toad bemoans the fact that they no longer have any cookies, Frog replies “Yes, but we have lots and lots of will power.”

I’m not sure that it is really willpower when you take away temptation, but removing tempting treats from my house is the best way for me to resist eating them. I have very little problem resisting “bad” food throughout the day, but the post-dinner hours are another story. It’s a boredom issue, I think. It’s also an issue that chocolate tastes really good and sometimes I crave it so much that it hurts. I’ve never been able to figure out why I am so satisfied with one piece of chocolate when it is a sample given out at Costco and then I can’t stop at one (~~five~~) at home.

I love cookies. I love candy. I love ice cream. I hate willpower.

Lest you think that Frog and Toad have it all figured out, the story ends with Toad’s scathing dismissal of willpower: “You may keep it all, Frog. I am going home now to bake a cake.”

I know what you mean, Toad.

Willpower

Posted on June 24, 2013 by Laddie

Willpower is passing this

and buying this

day after day after day.

It’s Not as Hard

Posted on June 20, 2013 by Laddie

I am at a stage in life where caring for my Type 1 Diabetes is easier than it has been for most of my life. I initially titled this post as “It Gets Easier”. I decided that to use the word “easy” anywhere on the same page as diabetes was a total travesty. Diabetes of any type at any time is always hard. Hard as rocks. Hard as nails. Hard as anything you can think of. But right now for me it’s not as hard as it used to be.

Partial hypo-unawareness makes it easier for me not to over-correct. No more sitting at the kitchen table in the middle of the night eating bowl after bowl of Frosted Flakes in a soaking wet nightgown. No more drinking an appropriate glass of orange juice followed by just one Wheat Thin that turns into half a box. Most of my nighttime lows are taken care of by one or two glucose tabs eaten from the stash on my bedside table. (Note to self: don’t tell your readers how often you silence Dex alarms to roll over and go back to sleep.)

I am currently retired from my part-time job and I am able to walk my dog every morning right after breakfast. Through most of my years with diabetes, breakfast has been my most problematic meal. The same meal could have post-prandial readings that varied by a hundred or more points from day to day. By walking immediately after eating, I usually prevent the extreme spikes that require large doses of insulin to bring me back to an in-range reading. Although I occasionally have an outrageous high with no discernible reason, most of my mornings are somewhat level and predictable now.

I am lucky to be able to escape Minnesota winters and spend several months in Arizona. This means that my exercise level can be consistent throughout the year rather than taking a nosedive in the endless dark, cold, and ice of winter in the Upper Midwest. I am a true believer that exercise is the key to a successful life with diabetes and consistency in exercise helps for stable basal rates.

My newest continuous glucose monitor, the Dexcom G4 Platinum, has improved my physical and mental health in almost immeasurable amounts. This is my 3rd CGM system (after the Medtronic CGM and the Dexcom 7+), but it is the first one that has been life-changing. Occasionally it will cry wolf for non-existent lows, but in general it is incredibly accurate and alerts me to lows before I reach the 50’s and 40’s. I can go about my day with the confidence that it will alert me when I’m out of range and it lets me forget diabetes sometimes.

At age 61, I’m past those pesky hormones that can wreak havoc with BG levels throughout the month. There are some definite downsides to having fewer hormones, but blood sugar control is not one of them.

I eat fewer carbs than I used to and average about 100 grams per day. In the old days, that was considered Low Carb. Because there are so many people who go much lower than that these days, I think I’m now on the low end of Moderate Carb. I believe that each one of us has to make our own choices when it comes to our diet, but I have never been able to match insulin to high carb meals and snacks. By reducing the post-meal peaks, I’ve gotten rid of many of the lows that result from preventing or treating those highs.

I think the reason I’m feeling good these days is that my hard work seems to be having good results. We’ve all had spells where we do the “right” things and diabetes just laughs at us. But right now it’s smiling. How long will it last? Probably not long.

So do I have Type 1 Diabetes figured out? Nope. I still love sweets and struggle with evening carbfests that lead to bad overnight highs and lows. I still have highs that make no sense at all. When I go high, I can’t seem to take enough insulin to bring my BG back to normal. I have daily lows in the 60’s and 70’s. I am fighting my third frozen shoulder despite having good A1c’s. I have to take diabetes into account for almost every activity in my life.

But most of the time, I’m doing okay. And that’s a win in my book.

Test Guess and Go

Even with testing, diabetes is a guess every day.