Not FDA Approved

Posted on November 26, 2016 by Laddie

After my husband and I finished putting up the Christmas tree this morning, I discovered that my Dexcom G4 Share receiver was missing. We searched tree branches, boxes of decorations, upstairs, and downstairs and couldn’t find it. I knew that the receiver was somewhere in the house because I was getting numbers on my phone through the Share app.

My BG at this point was in the 140’s several hours after breakfast and normally I would take a correction bolus. Instead I ate a couple of glucose tabs and hoped that I would hear vibrating alerts as my BG passed over 160. No luck. My BG went up but we heard nothing. (All of my alerts are set to Vibrate.)

Once my BG hit the stratosphere, I gave up on high alerts. My only recourse was to drop below 55 and get the mandatory audio alert. I injected a mega-dose of insulin and got ready for the gluco-coaster ride. Don’t try this at home, Kids.

It took a while but eventually I was below 100 with double down arrows. About this time my husband asked if an ambulance ride would cost more than replacing the receiver. I explained that I had reached my deductible for the year so emergency care would be free…. Then I assured him that I would be okay and ate a couple of Smarties to control the BG drop.

We didn’t hear vibrations as the BG dropped below 70. So it was 55 or Bust!

Finally we heard muffled audio beeps, but we couldn’t figure out where they were coming from. Certainly not near the Christmas tree or the couch or the many boxes where I expected to find it. I’m not sure how many minutes separate each series of alerts—maybe about ten. Finally on the 3rd or 4th round of beeps, we found the receiver upstairs in the pocket of my pajamas.

This should be the end of the story, but it is not. The reason that I had not checked upstairs is that I had been on a 40-minute walk long after getting dressed. I had seen reasonable BG numbers on my Apple Watch while walking and given no thought to the idea that the receiver was not with me.

It turns out that obviously my receiver was upstairs all morning and the number I was seeing on my Apple Watch was from the Watch Sugar app. When the Dex Share app on the phone and watch loses contact with the Dexcom receiver, it displays blank dashes instead of numbers. Had I been using this app during the walk, I would have noticed a problem. But I was checking my watch face with the Watch Sugar complication. Well, I learned today that the Watch Sugar app will keep displaying the last number received whether it is 30 seconds ago or 5 hours ago.

Once my BG returned to normal according to my meter, I turned off the Dex receiver for 20 minutes. As expected, the number 46 for Watch Sugar never changed while the Dexcom Share app (not shown on watch face) quickly showed no data. Hypothesis confirmed. watch-face

Everything is now fine in Diabetes Land.

I found my Dexcom receiver.

My post-Thanksgiving low carb diet got blown to bits with glucose tabs, Smarties, an apple, a pear, yogurt, and an English muffin.

I learned that it is better to keep the Dexcom app open on my watch rather than rely on Watch Sugar.

My BG’s are stable and back in range. Dexcom 91. Freestyle 93.

Just another day with Type 1 diabetes.

Postscript: Sometimes I think I have little control over my diabetes. Today I felt totally in charge of what I wanted my blood glucose to do. I never felt that I was doing anything dangerous. I was not alone and I had lots of orange juice and glucose tabs available. That being said— please remember that nothing you read on this blog should be considered medical advice or even good advice.

Back to the Future: Dexcom G4 Share and Apple Watch

Posted on October 11, 2016 by Laddie

In the last 10 days, my diabetes technology world has changed. On one hand I have reverted to an older tech platform. On the other hand I have zoomed into the future with a modern and cool-for-a-64-year-old-woman device.

Stepping Back: After getting my free(!) upgrade to the Dexcom G5 last fall, I was lucky to be left with an unused G4 transmitter. I didn’t start using the G5 until March when my previous G4 transmitter passed its 1-year anniversary. It was still working fine, but I abandoned it to transition to the G5 platform. A bit wasteful, but gee whiz, that transmitter was never going to die! I used two G5 transmitters and for the most part was happy with G5.

That unused G4 transmitter did not disappear and kept sending “Use Me! Use Me!” messages to my brain inbox. If I were not moving to Medicare and no CGM coverage in 6 months, I probably would have used my “privileged diabetes patient” status to stay with G5 and give the unused G4 transmitter to a needy DOC friend.

Last weekend my second G5 transmitter timed out and I bit the bullet to go back to G4. My CGM warranty expired in early September and I was able to order a new G4 Share receiver. Although it had only been 6+ months since I had last used Share, I panicked as it seemed totally foreign to me. Also because I am using the mySugr logbook, I needed to be sure that my CGM information would continue to sync to the app. Miraculously I figured everything out and it is working correctly.

Onward to the Future: Earlier this fall I decided that I would use my #firstworldprivilege to order an Apple Watch so that I could see my current blood sugar just by raising my wrist. Please remember that I started my diabetes career in the days of urine testing and things like this are magical to me. d-tech-privilege-circle

My Apple Watch 2 arrived last week. I have not worn a wristwatch in 12+ years since I got my first insulin pump, aka pocket watch. It wasn’t terribly difficult to add the Share app to the watch and it works okay. Unfortunately it cannot be used as a watch face “complication” like the G5 app. There is another app called “Watch Sugar” that allows me to add the Dexcom number to my watch face, but it is so time-delayed that I don’t find it helpful.

Basically I leave the Dexcom Share app open on the watch all of the time and it is usually what I see first when I raise my wrist. When Share is not the wake-up screen, it is easy to find the app in the dashboard and restore it. My difficulty with this whole set-up is that occasionally it just doesn’t work. If I am using other Bluetooth devices such as headphones or a speaker, I think the phone gets confused and occasionally loses the signal from the Dexcom receiver. There are also user-error problems such as leaving the receiver upstairs or closing out the Share app on my phone.

Clash of the Past and Future: The bad part about these D-tech changes is that now I have two more devices to carry, coordinate, and charge than I did two weeks ago. The G4 requires a receiver and of course the watch is added. The blood glucose number that I see on my wrist starts with the transmitter beaming info to the receiver which communicates with the phone that sends it to the watch. There is definitely some mental fatigue and data overload with this set-up. At the same time I love not having to reach into my pocket to retrieve Dexcom data.

Life is good. It ~~might~~ would be nice if I didn’t diabetes but that horse left the barn a long time ago. So today I give thanks for access to technology that make my life with diabetes a little bit easier and a lot more interesting. 😀

The Vibe After Two Months: Part 1 – Report Card

Posted on April 9, 2015 by Laddie

I have been using the Animas Vibe for two months. I believe that the decision to upgrade from my two-year old Ping was a good one and I am content that this will be my pump until the warranty expires in November 2016. The basis of this satisfaction surprises me because the reasons I like the pump have little to do with why I thought I wanted it.

I am writing a 3-part series about my experience. Today will be an overall report card for the Vibe, primarily discussing whether it makes the grade as a pump/CGM system. Part 2 will be an evaluation of how the Vibe performs as a CGM receiver. Part 3 will be an evaluation of the Vibe as a stand-alone pump.

In November 2012 I made the decision to purchase the Animas Ping because it was in line to be the first pump integrated with a Dexcom CGM. Despite poor results with the Medtronic SofSensors, I had really liked the integration of CGM data into my Revel pump. After using a Medtronic pump along with a Dexcom CGM for several years, I strongly believed that I wanted a single device merging my insulin pump and CGM.

When the Vibe was finally released in January 2015, I began to question the wisdom of following through with the upgrade. I was concerned that the CGM software was already out-of-date, that future Dexcom transmitters would lack compatibility with the Vibe, and that I might have insurance problems getting a new CGM system because the Vibe functions as a CGM receiver. After meeting with an Animas Rep in early February, I made the decision to follow through with the upgrade. You can read about that decision and my early impressions of the pump here.

After two months, I am happy with the Vibe as a pump, but I am back to using the Dexcom receiver full-time. In my opinion, the Vibe gets a poor grade as a SYSTEM in real time and earns a good grade in reviewal made. To clarify, the integration of the CGM into what is essentially an Animas Ping pump is clumsy and occasionally nonsensical when it comes to the decisions/actions that I make with my pump and CGM on a daily basis. It is difficult to move from the CGM functions of the device to the insulin pump functions. Unlike the Medtronic “system”, there is no meter that sends BG numbers automatically to the pump. At the same time because I can download the Vibe to Diasend along with my BG meters, Dexcom receiver, and now even my Fitbit (!), I have a great platform for merging and reviewing my diabetes and health data.

In a January review of the Vibe, Mike Hoskins of Diabetes Mine mentioned that his Animas trainer talked about the Vibe “in terms of a dwelling — the two components used to be separate housing units, but now they co-exist under the same roof and are more like different rooms within one big home.” That is a great image, but I take it even further to say that the Vibe is a duplex with the pump in one unit and the CGM in the other. They are adjacent to each other, but they have separate entrances and there are no adjoining doors. To get from one device to the other, you must go outside and walk down the sidewalk to the other side of the building. Rather than adding value to each other, I find that the CGM part of the Vibe makes the pump functions more cumbersome than they are when the CGM is disabled.

Duplex Vibe

The only time that the Vibe works well as a system is when all of my devices have been downloaded to Diasend. In reviewal mode, it is a success because I can see reports merging pump and meter data with my CGM. Unfortunately it is time-consuming to download everything (especially the Vibe) to Diasend, so it is unlikely that I will do this frequently. I am starting to get a little cyborg excitement envisioning an Apple watch showing real-time Dex tracings, Fitbit steps, and insulin pump data. A brave new world for sure and definitely not what the Vibe delivers.

In the next post in this series, I will write about how the Vibe functions as a CGM device and talk about what I consider some of the shortcomings of the Dexcom integration. Part 3 of the series will highlight my views on the Vibe as a stand-alone pump.

As a hint of what is to come, I like the Vibe as a pump. At the same time, I have become comfortable with the idea that longterm my CGM data is going to end up on my phone, Apple/Pebble watch, or some other device. Unless the CGM integration improves the function of the pump and does more than be a poor replacement for a Dex receiver in my pocket, a pump/CGM combo doesn’t seem to add much value to my diabetes life.