Two Life Hacks and a Story

Laddie_Head SquareGoing Home with an Animas Ping/Vibe:  I have been using an Animas Ping pump for over two years and still go crazy with the convoluted menu system. One of the most frustrating things is the lack of an Escape or Back button and I have b*tched about that more than once, twice, ten times, a hundred times. Many bloggers reviewing the just-released Animas Vibe complained about the same thing.

in the Animas Users Group at TuDiabetes, a Norwegian Vibe user with the screen name of Siri (not my iPhone Siri) told me about a shortcut to escape the endless menus of Animas pumps and return to the home screen. Just press the Audio Bolus button on the right side of the pump. Then press the OK button or any key on the front of the pump. You will be returned to the home screen. Siri learned this from her Animas Rep.

With this trick, I will probably save an inconsequential 5 minutes a year, but I will save myself oodles of frustration. Honestly I have to admit that in the last couple of months, I have become so adept with my Ping that I really don’t hate it anymore…. I am definitely looking forward to receiving my Vibe:-)

iPhone trick:  Younger readers of this blog who have grown up texting probably know about keyboard shortcuts. Even I knew about them and had seen the “omg” already programmed into my iPhone and iPad. Because I text like an “old person” and type out exactly what I want to say, I never bothered using shortcuts and never programmed any into my phone. A couple months ago after being annoyed about having to type my email address into so many online forms, it dawned on me that I could use a keyboard shortcut for my email address. Therefore I programmed “mgm” into my phone as a keyboard shortcut for my gmail account.  I set up “mcm” for an alternative Comcast email account. “tgg” enters my blog web address. These shortcuts work on most websites and blogs and save me a lot of error-filled typing.

To set up a keyboard shortcut, go to Settings/General/Keyboard/Shortcuts. Click on the + in the upper right hand corner. Enter your email address as the phrase and a series of letters for your shortcut. One glitch is that a space is automatically entered after your email address when you press the space bar to use your shortcut. That is great for emails and texts, but most website forms interpret this space as meaningful and will reject your address. So after the email populates itself, you may have to backspace before entering your password. Keyboard shortcuts entered on one device automatically show up on your other Apple devices.

If you decide to give this a try and like it, just remember that you learned this from a 62-year old woman. It is never too late for this old dog to learn new tricks!

A Story:  Last Wednesday I hiked in the morning with a group of friends. I came home, cleaned up a bit, and had lunch. The refrigerator was empty so I went to “town” to shop. In the winter I live in the boondocks of Arizona and have a 20+ minute drive to the grocery store. Although I had drunk a lot of water on my hike, I was still thirsty and grabbed a can of carbonated water for the road.

I went to the hardware store, took Abby the Black Lab to the dog park for tennis ball retrieving on grass, and went to Safeway to buy food (low carb of course!). I was still thirsty so stopped by the adjacent convenience store to buy an unsweetened iced tea to carry me through the afternoon.Bud Light Box I grabbed the almost empty can of carbonated water to throw away and gasped as I saw it was a can of Bud Light! I had been driving around town drinking beer. Arizona has no-tolerance laws for alcohol and driving and I think that I would have been thrown in jail had a policeman seen me chugging beer as I completed my errands.

Bud Light in cans is not our beer of choice. I think this can was 3-4 years old and a remnant of the last time my husband entertained Minnesota golfing buddies in our winter paradise. Because I try to avoid Diet Coke, I drink enough weirdly-flavored carbonated water and iced tea drinks that a flat, tasteless beer didn’t register as something I shouldn’t be drinking.

I’ve told this story to many of my local friends. Everyone proclaimed that I was the last person that they would have envisioned drinking and driving at lunchtime. They also swore that they would have visited me in jail. It is a funny story that is actually quite terrifying.

When I got home, I checked my refrigerator’s “canned water” bin and there were no other cans of beer. I wish that I had checked the date on the beer can to see how old it was. At the same time I am glad that this is just a funny story told from the safety of my living room. Because I was totally unaware of what was going on, I have no idea how I would have tried to explain this to a policeman.

Summary: One diabetes hint, one iPhone hint, and a story about drinking and driving. Sounds like a great blogpost to me:-)

The Grouch Addresses D-Tech

Laddie_Head SquareI am a tech-happy Type 1 diabetic. A new diabetes device gets my heart racing and I treasure my D-devices almost as much as my iPhone and iPad. Maybe more? Nah…. Until there is an iPump, I will love my iPhone and iPad more. But my life is immeasurably better because of my insulin pump, continuous glucose monitor, and even blood glucose meters.

I have come to terms with riffraff hanging off my body and filling up my pockets. I don’t mind the daily minutiae of using these devices and I take things like changing infusion sets and poking my fingers in stride. I’m old enough that I don’t wear cute dresses any more and don’t have to worry about accessing a pump tucked in my underwear. I don’t care about black dots on my fingers and the red spots and occasional bruises that tattoo my body. I am not burdened by my diabetes devices.

At the same time I am very frustrated with my D-devices.

I have been using an Animas Ping since 2012 and am still irked by its menu system. Two years ago I made the decision to purchase this pump despite its shortcomings because I thought the release of the combo Ping/Dexcom device was just around the corner. My Bad. It’s now November 2014 and the rumor these days is that the Vibe release is just around the corner….

Some of my frustration for this delay is directed at Johnson & Johnson which didn’t submit the pump to the FDA until April, 2013 after several years of hinting that the submission would be in the near future. The Vibe was released in Europe in June, 2011 and I sit here 3-1/2 years later hoping to upgrade to one. The fact of the matter is that when the Vibe is finally released in the USA, it will be a 4-year-old pump. In some ways it will be little different than the Animas Ping as it was approved by the FDA on July 1, 2008.  So you could argue that Grouch D-Techthe Vibe is really a 6-1/2 year old pump. My understanding is that the G4 software update just released by Dexcom will not be included in the Vibe. Therefore the Vibe will be an old pump integrated with an out-of-date Dexcom receiver.

In general I am incredibly frustrated with the whole FDA process. I don’t understand why it takes a couple of years to review something that has been in use in Europe for several years. I don’t understand why if Dexcom has been given FDA approval for its latest update that neither Animas or Tandem will be able to include that update in their pumps that integrate with the Dex G4. In my opinion the lengthy FDA approval process punishes innovation and motivates manufacturers to stay with old devices superficially decorated with trivial new bells and whistles. Many or most diabetes tech devices are developed by US companies and we see the overseas market getting access to them years before we do. It’s cheaper and faster for manufacturers to get approval in Europe.

Are users of diabetes tech safer in the USA than in Europe? I’ve never seen proof of that.

The iPhone 4 was released in April, 2011. Some of you might be using it happily: unless you want to use IOS 8 / unless you have a new iPad which can’t use iCloud optimally unless all of your devices are using IOS 8 / unless you don’t mind your phone freezing up on multiple websites and apps / unless you want a beautiful, new sleek device. What if you had to purchase an iPhone 4 today and pay the same price as an iPhone 6?  Yeah, that’s the same excitement (not!) that I feel about the Vibe when and if it is ever released.

Yes, the FDA is trying to keep me safe. Please don’t tell them that the most dangerous thing I can do is go back to injections and accidentally substitute my fast-acting Novolog for my Lantus shot. Or carelessly give my basal insulin twice because I couldn’t remember if I had already given the injection. Insulin is a dangerous drug and everyone with Type 1 diabetes knows that we occasionally play Russian Roulette with our lives.

I recently read Cell by Robin Cook where a smartphone app called iDoc became an integral part of the medical care for test subjects. People with diabetes were implanted with an internal insulin pump that was controlled by iDoc.  iDoc was a master of blood glucose control until the patient got another medical condition (cancer, heart disease, etc.) that threatened to make their health care costs skyrocket. At that point, iDoc programmed a lethal dose of insulin for the diabetic patient. Dead as a door nail. Maybe I would like some FDA oversight on iDoc….

Continuing my frustrations with D-Tech, last Thursday I read reports of the new software release for the G4 by Dexcom. I quickly tried to update, but the Dexcom website was having problems. Kind of like the FDA crash on Monday, Nov. 3 at the #DOCasksFDA event. Don’t these people know that the DOC doesn’t fool around when it comes to sharing information? We arrive quickly and in large numbers and don’t fool around. There is no such thing as a trickle down release of information in the DOC.

Fortunately the Dexcom website was back working in an hour or two and I successfully updated my Dexcom receiver. Because my current sensor was almost two weeks old, I started a new sensor to inaugurate the new software. It ended up being the worst sensor start that I have ever had in my two years of using the G4. Within a few hours, I had Dex results that were a hundred points too high. A recalibration resulted in Dex results that were 80 points too low. Two days later the results were still not in line. Argh!

I hate D-Tech.

My Dexcom debacle has a happy ending (I hope!) and several of my last sensors are being replaced. I had been having problems before the update and I think the rotten sensor start was just an unhappy coincidence. I have had superb customer service from Dexcom in the last couple of days. The jury is still out on whether my problems have been sensor related or equipment related, but I am hopeful that I am back on the right track.

Totally unrelated to my rants in this post, my pump case cracked yesterday when I inserted a new battery. I called Animas and only had to wait 2-3 minutes before talking with a Pump Rep. A new Ping will arrive on my doorstep tomorrow.

Okay, maybe I love D-Tech.


Diabetes Soldiers

Banner_DBlog Week

Today’s Topic:  Back for another year, let’s show everyone what life with diabetes looks like!  With a nod to the Diabetes 365 project, let’s grab our cameras again and share some more d-related pictures.  Post as many or as few as you’d like.  Feel free to blog your thoughts on or explanations of your pictures, or leave out the written words and let the pictures speak for themselves.


Laddie_Head SquareIn yesterday’s post, I mentioned that I am trying to convert from a Windows user to a MacBook junkie.  It hasn’t happened yet. I am a MacWinBookDows person. I need them both.

Today I started with a photo of 52 crystals lined up in a row.  The crystals are the beautiful blue pieces that operate my Animas reservoirs. A long time ago I learned that I don’t need to change my reservoirs on the same schedule as my infusion sets. Each reservoir lasts me for about a week. So these 52 crystals represent a year of reservoirs for me.  A year of insulin. A year of life. These crystals represent the soldiers that keep me alive. Day after day. Reservoir after reservoir. Week after week.

They remind me of Chinese soldiers. All in a line. Powerful, but regimented. One, two, three, four, five. The Great Wall of China.

My kitchen has back splash tiles that measure 3.5 by 3.5. Add in the grout and each tile embraces 5 Animas crystals.10 tiles with 2 leftover crystals equals a year.

This morning I lined up 52 crystals. I cropped my photo and then used various filters in Pixelmator to show my Diabetes Soldiers in different costumes. I couldn’t figure out how to do the final cropping on my MacBook, but Photoshop on my Windows Desktop delivered my final photo: Diabetes Soldiers, Diabetes Soldiers Black & White, Diabetes Soldiers Sepia, Diabetes Soldiers Green, Diabetes Soldiers Blurred & Colored, Diabetes Soldiers Bumped, Diabetes Soldiers Vortex and Colored, Diabetes Soldiers Inverted.

Diabetes Soldiers. One, two, three, four, five. Animas reservoirs keep me alive. One, two, three, four, five. Insulin keeps me alive.

Every day.


Untethered at the Beach

Laddie_Head SquareMy 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.

Beach GraphicsAlthough 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.

Lantus and PumpIf 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  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.