The Vibe is Approved!

Laddie_Head SquareThe Vibe is approved.

I say “Finally!” but I say that with excitement not grouchiness.

Kerri of Six Until Me has a sponsorship relationship with Animas and shared the news this morning on Facebook. Rather than have me repeat her words, check out her blogpost here.

I will definitely upgrade to the Vibe once I learn the details of the ezAccess Upgrade Program. When I purchased my Ping two years ago, I was guaranteed a $99 upgrade fee to the Vibe when it was released. I didn’t think that this pump/Dexcom combo would take so long to come to market and I might have purchased a different pump had I known the wait was going to be so long. On the other hand, I don’t know what pump I would have purchased instead and I am glad today to have the option of ordering the Vibe.

Although I am not as excited about the Vibe release as I would have been a year ago, there is no risk for me to upgrade. I previously wrote that the Vibe will not have the recent Dexcom software upgrade. I have also worried that the small Dexcom screen might not be big enough to  show my Dexcom graph clearly and I am concerned about the difficulty of seeing the Vibe screen in the sunlight. The Dex receiver doesn’t perform well in the sunlight either, so that is probably a toss-up. If I don’t like how the Vibe works with my Dexcom, I can just disable it on the pump and go back to using my receiver. Or my understanding is that I can use both devices simultaneously. So no risk.

The Vibe will also get rid of my biggest dislike of the Ping because the recommended bolus will self-populate rather than make me scroll up to it from zero. Huge improvement!  People who use the remote meter with their Ping may have to thing twice about upgrading to the Vibe because my understanding is that the new pump will not have this feature. I do not use the remote so that is a non-issue for me.

As you know, I have been one of many people working to have Medicare approve CGMS for seniors. If that does not happen by the time I get to Medicare, the Vibe eliminates the need for a CGM receiver and that will save me money. However, I don’t think it is known whether the Vibe will be covered by Medicare and the ezAccess Upgrade Program brochure states that “Medicare patients are not eligible for ezAccess.” Because I am still using private insurance and my Ping is in warranty, I am eligible at this time and I can wait to see how it plays out with Medicare.Vibe Upgrade

So this is an exciting day and I look forward to my upgrade to the Animas Vibe.  Although I struggled with the Medtronic Sofsensors, I really liked my years of having my CGM integrated with my pump. I like having one less thing to carry.  And I like having my CGM attached to me with the tubing of my pump. I have never permanently lost my Dex receiver, but I always worry about it. I also like that my cgm receiver will be integrated in a waterproof pump.

Click here to read the news release.  It indicates that the pump will start shipping in January 2015. Once again, thanks to Kerri for sharing this link on Facebook:-)

I was able to order my Vibe this morning by calling the Animas
number 1-877-937-7867 and pressing Option 3. I spoke briefly 
with one agent and was then transferred to another representative
who helped me with the upgrade. Just so you know, I will actually
be charged $799 for the upgrade and receive a $700 credit when
my Ping is returned. So the final cost of the upgrade is $99. For
fun and excitement, I ordered my Vibe in blue.

The Grouch is Back!

Laddie_Head SquareTwo weeks ago I wrote a grouchy blogpost about my frustrations with diabetes devices. Things got a little better for a while, but today THE GROUCH IS BACK!

I am sitting here with a high BG that is 99% likely the result of an infusion set change earlier today. I find that no matter what kind of set I use, I more often than not get highs after insertion. I have a grab bag of tricks that I use to avoid the rise, but none of them worked today. I finally gave up and inserted a new set.

These problems are not the fault of my pump, but they are the fault of an insulin system that makes me utterly dependent on the short-acting insulin delivered by my pump. Why should I have to accept high BG numbers for 4-6 hours every three days? I hate these “blameless” highs. I ate a small breakfast today followed by a 3-mile walk. Then I changed my infusion set and my BG climbed from the 80’s to the mid 200’s in the next couple of hours. If I’m going to have a snarky high, I should at least get to have a cupcake or a chocolate-covered donut.

My Dexcom G4 was not an innocent bystander to this mishap. In fact it was continuing its 2 month vacation from accuracy. Because I felt good and the Dex showed my BG to be level, I didn’t test after breakfast until late morning. I was surprised to see a BG of 181. It didn’t make sense so I tested again: 180. I took a correction bolus and calibrated the Dex which was off by 75 points. I was well up in the 200’s before my BG began to fall as the result of several correction boluses and the new infusion set. When my BG finally started to drop, I gave the Dex an extra 30 minutes to see if it would react. Not even close and I recalibrated it downwards. This is the third day of a sensor that has been a problem from the start.

So what am I going to do besides tear out my hair and curse everything related to diabetes?

First I’ll call Dexcom whose reps have been very helpful by replacing sensors and giving advice during the last couple of weeks. I’ve been using new hardware for the last month and the next step might be to try another new transmitter.

Secondly I am going to make changes to my insulin regimen. In a recent post titled Lantus is Lovely and Amazing,  Katy of Bigfoot Child Have Diabetes revisited the idea of her son using Lantus in tandem with his pump. She saw the benefits as minimizing the effects of a pump failure/bad site and a way to give her son more flexibility for water activities and in general some pump-free time. The use of the pump along with Lantus (or Levemir) is called the Untethered Regimen and is best described by Dr. Steve Edelman in a 2004 article. I have used the untethered regimen several times on beach vacations and wrote about it in a July 2013 blogpost.

I have always thought that the untethered regimen makes a lot of sense. An infusion set insertion, a bad site, or a pump problem will have less of an effect with Lantus in the background. Because you take some of your basal with the pump, you still have the ability to reduce or increase basal rates as needed. I’ve had great success when I have used the Lantus/pump combo in the past and as I said in a comment on Katy’s post: “It works so well that I’ve often wondered if I should do it all of the time.”

So that’s what I am going to do. It’s time to experiment with changing up things because I am not happy with where I’m at. I’ve lost confidence in my ability to get good results by doing my normal “right things”. Of course the real villain here is Type 1 diabetes and there is no doubt that I am going through a bad period where minor things are affecting my blood sugar quickly and erratically.

I have ordered Lantus from the pharmacy and will start using the untethered regimen when I have the long-acting insulin in hand. Will I stay on a combined Lantus/pump regimen for the rest of time? Probably not, but I think it will make things easier in the near future. It could be that I just need an increase in basal, but I’m tired of tweaking things and overreacting to highs and lows.

One thing that I always try to remember is that my body does not know the difference between bolus and basal insulin. Formulas and rules of thumb are just that. Sometimes I need to be creative to figure out ways to deal with blood sugar excursions. Please realize that I have used the untethered regimen before so this is not me going off wildly without understanding what I am doing. I see my endocrinologist in two weeks and this will certainly give us something to talk about. She knows that I am a headstrong and self-managing patient and she has never been upset by that. In fact she always emphasizes that this is “my diabetes” and she is my coach.

The final topic for today is related to syringes. Whenever I’ve used syringes in recent years, I have pulled them from a box purchased on 11/15/04. Do you think I should buy new ones???

Syringes_Old

Disclaimer: Nothing I say here should be construed as medical
advice and please do not change your insulin regimen without
consulting with your medical team.

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.

 

I am Blessed

Laddie_Head SquareToday was a reminder that I live a very blessed life.

This morning my new Dexcom G4 system arrived by FedEx. I currently have good insurance and all it took was one phone call on Monday to have this fabulous medical device show up on my front porch today.  Proving that I don’t live in a rut and am easily amused, I am somewhat excited that my new receiver is blue and replaces my out-of-warranty hot pink receiver.  Life is too short not to grab every opportunity to be happy.

Dexcom Blue Excitement

This afternoon the UPS guy delivered a big box containing 3 months of infusion sets, reservoirs, and test strips.  These supplies were ordered through the Edgepark website on Sunday.  Many people totally bad-mouth Edgepark, but once I learned to ignore the wacky prices they quote for “Retail”, I have had excellent service from them.  (I hope that I have not jinxed myself.)  I was told by a rep in the CGM/Pump department at Edgepark that my good insurance is one reason that things have gone so smoothly for me.  I also give credit to my endocrinologist whose multi-doctor practice is very organized and responds quickly to requests for prescriptions and medical necessity forms.  Nothing was too exciting in this order except that it includes one box of Contact Detach metal sets that I have never tried.  Some Type 1’s at TuDiabetes swear that they are the best, so I figured they were worth a try.  Earlier this summer I tried out Cleos and Insets and neither worked well enough to lure me away from manually inserted Comfort Shorts.

For those of us who participated in the Spare a Rose campaign, my ease in getting needed diabetes supplies is in stark contrast to the difficulties that many children/adults in developing nations have getting insulin to keep them alive.  I won’t need to buy insulin until September.  When I do, all it will take is a few clicks on the computer and a drive to my local Walgreens to replenish my deli drawer with insulin (my refrigerator does not have a butter compartment!).

I wish that I didn’t have diabetes.  But I am blessed because I have supplies on the shelf, a pump in my left pocket, a CGM in my right pocket, and plenty of insulin in the refrigerator.  Not everyone is so lucky.

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Thanks to diabetesherosquad.com for permission to use their Dexcom graphic.

Endo Appointment

Laddie_Head SquareI have an appointment with my endocrinologist this afternoon.

Last week I wrote myself a note to call and postpone this appointment.

I’ve gained about 5 pounds in the last year. I’m thin and that is not the end of the world, but for me this is a big gain. I am now over a threshold number that I haven’t seen in ten or twelve years. My endo is pretty observant and I suspect she is going to notice the pounds. I keep reading research reports that indicate that people who are thin and people who are obese have the worst life expectancy numbers. So I can argue that it is good for me to have gained weight and maybe it is. Or maybe not. Or maybe it doesn’t matter at all. None of that changes the fact that I have gained weight that I am having a hard time losing.

My Dexcom graphs are ugly. I have a 10-year run of A1c’s that I privately take great pride in. But it is rare that I have a blood draw that I don’t think that this is the A1c that will end my streak. We read about hypoglycemia unawareness and hyperglycemia unawareness. Even with Dexcom Studio and Diasend (and previously Carelink), I definitely have A1c unawareness. I don’t have a clue what my report card will reveal. I do know that if I postpone this endo appointment, I can definitely have better results in a week month year.

I have had great success in the last couple of years by reducing the number of carbs that I eat. I strongly believe that diabetes, whether Type 1 or Type 2 is a disease of carb intolerance. I’ve read books like Why We Get Fat by Gary Taubes, Wheat Belly by William Davis, and The Diabetes Solution by Richard Bernstein. These books make sense to me. You need to read these books.

My weight gain is the result of following a low carb diet with plenty of high calorie foods such as cheese and nuts and then eating carbs In addition to that diet. My Dexcom tracings are good during the day. A glass of wine, dinner, and then cravings for nuts and SF Jello with mounds of whipped cream lead to lows at midnight followed by Himalayan spikes at 2:00AM.

But I didn’t cancel the appointment. Avoiding this appointment would be little different than hiding candy bar wrappers in the garbage. Avoiding this appointment would be little different than not testing my blood sugar because I don’t want to see the result.  Endo OfficeAvoiding this appointment would be little different than refusing to step on the bathroom scale. Avoiding this appointment would be hiding and in some ways “lying by omission”.

Not getting an A1c today doesn’t change the patterns of my blood sugar for the past few months. Whatever the status of my health is today isn’t going to change by not printing out my Dexcom tracings or Diasend reports. I am an adult and for better or worse, I need to be accountable for my lifestyle and decisions.

Avoiding my doctor is a slap in the face to her education, experience, and value in my life. She has never belittled me or made me feel guilty. She has always supported me and made sure that I have access to the latest medical technologies and the most appropriate medications. She is my doctor in order to help me live as healthy a life as I can with Type 1 diabetes. How can she help me if I don’t go see her and tell her the truth?  Maybe she will have some suggestions to level out my BG at night so that I can have an occasional CGM alarm-free night. Maybe she will say something to help me get back on the right self-care track. I am starting to have more autoimmune/inflammatory issues and maybe she will have some advice about whether I should give a gluten-free diet a try.

So I am going to see my endocrinologist this afternoon and I think I’ll survive it.

Dexcom Cases: Big News!

Laddie_Head SquareIf you use the Dexcom G4 and have been searching for the perfect case for your receiver, I have great news for you!  Yesterday on Facebook I read that Tallygear has come out with a silicone skin that is similar to the cases that many of us use on our cellphones.

In the year and a half that I have been using the G4, I have invested more money than I care to admit trying to find the perfect case for my G4 receiver.  The black leather case provided by Dexcom is huge and extremely masculine.  Great if you want to wear the receiver on your belt, but incredibly clunky if you like to keep it in your pocket.  I tried a few cases designed for Blackberry phones and they almost worked.  But not quite.  A few other cases from Amazon were quickly returned or tossed in the trash.

I ended up using two cases that were okay, but not exactly what I wanted. The first was a case that I found out about in the Dexcom Users group at TuDiabetes.  It was designed by the friend of a Dexcom user and was manufactured with 3D printing at Shapeways.  It has been my main case, but the color has faded terribly.  Although my receiver has survived more than one fall while in this case, I’m not convinced that the case provides much protection especially as it has gotten older and more flimsy.  You can check out this case here.

The other case that I have used was purchased at Tallygear.  It is a lycra fabric case with a clear plastic front that completely encases the G4 receiver. It has a loop to which you can attach the carabiner clip and lanyard that are included with the purchase.  I use that case for hiking and will continue to do so. I loop the lanyard through my belt and feel confident G4 Case Discardedthat I won’t lose the receiver off the side of a mountain. Although it is not completely waterproof, it does protect the receiver from a quick dousing in the toilet.  (My friend Jenn of Sweet Zoo has firsthand knowledge of that fact.)  I personally don’t like how the plastic front sticks to the screen and it has never been my everyday case.  But it’s great for hiking, great to wear around your neck, and a good case that provides cushioning and protection for the receiver.

I am thrilled to see Tallygear is producing a silicone case.  This is what I have wanted all along and I will be ordering one right away.  According to Facebook and the website, red is the only color that is immediately available. Orange, purple, blue, and black are available for pre-order and should be available in a few weeks.  This case does not provide protection to the front of the receiver and I will use a phone screen protector cut-to-size just as I am using now.  The price of the case is $17.95 with a shipping charge of $5.95.  You can save 10% by using the coupon code DexG4.

To check out the new case and to order one, follow this link.  I will be placing an order for purple.  My Dexcom is pink and red just won’t work.  Black might look the best, but with granddaughters who love pink and purple, I’m going with the Double-P/Pink-Purple look.

Thanks Tallygear

Tallygear was founded in 2008 by the parents of a daughter with Type 1 diabetes and sells pump/cgm accessories in colorful, fun fabrics.  They are incredibly responsive to the needs of adults and children with diabetes and I encourage you to support them.  If you’d like to learn more about Tallygear, check out this 2013 post on Diabetes Mine.

I anxiously look forward to my new purple Tallygear silicone skin and will try to remember to post a photo when it arrives.  My number one wish is for the Animas Vibe to finally be released so that I no longer need to carry my Dexcom receiver.  But until then, I say thank-you to Tallygear!

If you explore the Tallygear website, you’ll also find the original G4 case in a rainbow of colors and patterns, a neoprene case which comes in solid colors and gives even more cushioning and protection, a Tallyband wrist or ankle holder, and of course the new silicone skin.  If a new Dex case isn’t enough excitement for you, check out the Tallygear decals for your G4.  Sometimes small things can add a big smile to your day.

Post-publication Note: After publishing this post, I found out that Pump Peelz makes clear screen protectors for the Dexcom G4 in addition to its other decorative “peelz”. I’ve ordered a set for $5 and they should be much easier to use than cut-up phone protectors because they are custom-designed. 

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Dexcom and Static

Laddie_Head SquareIn my recent post about a blogging vacation, I made a notation on my Dexcom tracing about static interfering with my CGM readings. This has actually been a significant problem for me this winter and deserves some explanation.

Most of us who use CGM’s and pumps have had frustrating phone calls with customer service reps who somehow blame a multitude of problems on the phases of the moon, user errors, and the ubiquitous static. This winter I had multiple Out of Range error messages with my Dexcom G4. My transmitter was out of warranty and was the first device replaced. The number of Out of Range and ??? alerts escalated and I had instances of not being able to enter calibration numbers. Dexcom has always been responsive to my calls and quickly replaced the receiver.

New transmitter. New receiver. Although the calibration errors were fixed, other problems persisted and I assumed that they were somehow related to my sensors. I use each sensor for 2-3 weeks and had been using the same lot number of sensors all winter. I know that the Dexcom manual indicates that Out of Range readings are related to communication between the transmitter and the receiver, not the sensors, but….

I called Dexcom and fortunately got a great technical support rep. We spoke a while and she started asking questions. What was I doing when the Out of Range problems happened? Walking the dog. Shopping at a Target. What was I wearing? Athletic clothes. Golf clothes. I don’t know because I didn’t think about it. Where was the sensor inserted? Mostly upper leg sites.

She indicated that she thought it might be a static problem. I wasn’t convinced but tried to stay open-minded. Because I had used the 7+ for several years and the G4 for over a year with virtually no Out of Range readings, it didn’t make sense to me that all of a sudden static was wrecking my CGM universe. I was surprised when at the end of our phone call, she indicated that she was sending me a new transmitter.

If you work for Dexcom, please quit reading now.

After the phone call, I immediately started wearing some of my cotton clothes. Magically I didn’t have any Out of Range problems. A few days later I wore my favorite synthetic fabric athletic pants. One dog walk later and I was Out of Range for several hours. I wore my golf shorts that are cotton, but have shiny polyester pockets and guess what. Out of Range problems.

After these episodes/experiments my last two Dex sites have been upper arms. No synthetic pockets full of pumps, CGM receivers, and glucose tabs electrifying my transmitter. No static. No Out of Range problems.

Arizona almost always has low humidity, but this year has been even drier than normal. Like most of the Southwest, rainfall has been almost nonexistent in 2014 and my area has only had measurable rainfall one time since January 1. For the most part my wardrobe hasn’t changed. I have worn the same two pair of REI hiking pants for almost ten years and never had problems with the 7+ or the G4 last year. My golf clothes and everyday capris are well-worn and experienced when it comes to diabetes. But the extra dryness Dexcom Avoid Static_Blackthis year must have thrown the G4 over the threshold of what the transmitter can tolerate. I have struggled with my skin this year more than in the past, so I think the G4 and I are both rebelling against the 2014 desert dryness.

Remember now if you work for Dexcom and didn’t quit reading before, please quit reading now.

I have not opened the new transmitter. The old transmitter has been working fine since I’ve been protecting it from static generated by mutant pockets of synthetic/electrifying and polyester/nylon materials. Should I feel guilty and call Dexcom to genuflect and confess my dual sins of synthetic fabrics and static electricity? Probably not. The new transmitter was sent to me with no conditions attached and I was not asked to return the old transmitter. I won’t abuse the possession of the new transmitter by selling it or giving it away. Like most people who use a CGM, I will sleep a bit better knowing that I have a back-up transmitter. Both times when I have begun using a new transmitter since starting the G4 in November 2012, I really didn’t think that there was anything wrong with the old transmitter. I never got a battery warning. I got things like ??? and calibration problems.  But if you have a new transmitter in your cupboard, they won’t talk to you about other problems unless you have started using the new transmitter. Both times the problems did not resolve until the receiver was replaced. So I think I prematurely sent two transmitters to medical trash before they truly bit the dust and I have never had the luxury of a back-up for even a few weeks.

I’m not trying to justify medical theft and if you work for Dexcom and are still reading (even though I warned you to stop!), you know where I live and can give me a call. Another somewhat moral issue I’ve been wondering about is whether I violate any trademark/copyright issues when I use images of medical devices in my graphics as I did today with the G4 transmitter. Because I am not profiting from my use of the image and it’s being used on a personal blog, I doubt that anyone is going to chase me down. Today I obscured the image big time with a sketch filter in Photoshop and don’t know whether that’s a good or bad thing. I will say that I really like today’s graphic and think it does a good job of illustrating the static issue.

I’m back in Minnesota now. Plenty of humidity with rain and snow. I’ll be curious to see how my Dex works this summer. I really like using leg sites in warm weather so that I don’t have a visible mess of the transmitter and dirty adhesive on the back of my arms when I wear short-sleeved shirts. I’ve given up sleeveless shirts forever. 60+ years of sun exposure and diabetes-related skin problems have motivated me to look for long-sleeved shirts that can be worn in warm weather. That will be a blogpost someday soon, but I’m still working with my dermatologist to figure out exactly what is going on and what, if anything, we can do about it.

My Guardian Angel Has Helping Hands

Laddie:  In recognition of November as Diabetes Awareness Month, Sue from New York, Sue from Pennsylvania, and I have written blog posts which will be published this week.  Sue from New York has written about her appreciation for medical devices that help keep her out of harm’s way.  This is a companion post to her wonderful post about the families of people with diabetes.

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Sue May 2013_Head SquareOn August 19 I wrote a blog post titled The Saints We Call Our Family.  In this blog I praised the family members who vigilantly keep us type 1 diabetics safe. I failed to give recognition to the medical devices that also keep us safe.  I figured that there was no better time than Diabetes Awareness Month to give credit to the diabetes hardware that helps keep me healthy year-round.

My Dexcom G4 Platinum continuous glucose monitor is one of my guardian angel’s Guardian Angel Sensor_Rhelping hands. It keeps me safe from rising and plunging blood sugar levels by giving out loud alerts that wake me in the middle of the night. It gives me constant feedback on how food and exercise affect my blood sugar. It is truly a life saver for insulin dependent diabetics.

My guardian angel’s other helping hand is my OmniPod pump. My pump has several useful purposes, one of which is calculating insulin on board so I don’t stack insulin when my blood sugar is high. My pump is also capable of giving me insulin in increments of five hundredths of a unit. That is an amazing thing, considering that insulin given by needle is measured by whole units.

Both of these devices have helped ward off the terrible hypoglycemic episodes that I used to have in the past. Emphasis on PAST. It has been three years since I have had a hypoglycemic episode when I needed external help.

My diabetes has been so much easier to handle since I’ve been blessed with these two miracles.

Sunlight and the Dex G4: A Bad Mix

Laddie_Head SquareI’ll start this post by saying that I am very happy with my Dexcom G4.  It is by far the most accurate of the CGMs that I have used, the previous two being the Medtronic Sof-Sensor and the Dexcom 7+.

But I think that it has one serious problem and I am surprised at how little I have seen written about it.

The G4 has a beautiful color screen and uses yellow for highs, white for in-range readings, and red for lows.  When I hike in Arizona and am in bright sunlight with little or no access to shade, I cannot read anything on my Dexcom that is in red.  I can see the white numbers the best and can vaguely see the yellow numbers.  But even when I put my receiver in the skimpy shade of a desert bush and use my hand to shield the receiver as much as I can, I cannot see the red numbers or read the red low alert screen.  My glasses have transition lenses which turn dark in the sun, but I think that it is a reasonable expectation that people spending time outside will be wearing sunglasses.

So when I am hiking with my G4, how do I know that I am low?  I can see the white numbers fairly well and the yellow numbers a little less well.  So if I can’t see the number at all, then I must be low!  I don’t think that is exactly how the CGM is supposed to work…

Dex and SunWhen my Dex alerts me to a low, I know I need to test and take action.  My alert threshold is set at 70.  Does the current alert mean my BG is 69 and a glucose tab or two will take care of the problem?  Or is it 49 and I’m in danger of falling off a cliff?  I can’t answer that question because I can’t read the number.  When I’ve been in bright light for a long time, it is also difficult to see the directional arrows to know if my BG is dropping, stable, or rising.

I’m sure the idea of using red for lows was thought to be a good one because red is often associated with danger and emergencies.  Unfortunately testing of the screen readability must have taken place in a lab not out in harsh sunny conditions.  I wrote a long email to Dexcom about this problem and never received a response.  I will call them soon just to get the problem on record.  I can see things on my iPhone screen in the sun, including red text, so a fix of this issue is not an insurmountable problem.  An easier fix might be to stop using red for any of the vital information.

There is a December 2012 thread in the TuDiabetes Dexcom Users group about this issue and I bumped it up on Monday to see if others ran into the problem this summer and there are a few new responses.  The original author of the thread was a cyclist who couldn’t see her G4 numbers and arrows without getting off the bike and moving into the shade.  As she said, this wasn’t a good option for races.

Is anyone else having this problem?  Any suggestions or solutions?

Rest in Peace, My Dexcom Transmitter

Laddie_Head SquareIn early June my friend Katie at Diabetic Advocate wrote about the death of her Dexcom G4 transmitter.  Because many of us got the G4 within a month of each other in October and November, my assumption is that we will soon be seeing a lot of posts about dead transmitters which only carry a 6-month warranty.  Sad to say I did not follow Katie’s advice to order a new transmitter as soon as I passed the 6-month mark.

Fast forward to mid-July when I was scheduled to leave for a week-long international vacation.  Three days before the trip, I got a series of Out-of-Range symbols with no readings for several hours each.  This was with my receiver in my pocket about 3 inches away from the transmitter.  When the sensor would reconnect, it said my battery was OK.  But then it would quickly go back to the no-transmission mode.  It was obvious that the grim reaper was hovering around my transmitter.

I had expected that I would receive more warning that my battery was failing.  Unfortunately I went from a perfect transmitter to a defunct one in a period of two days.  I am used to the battery icon on my pump that goes from full charge, to 3/4 charge, to 1/2 charge.  Well, that is not how my G4 transmitter failed.  There was no message that “I am working perfectly now, but I am feeling low.”  It was “Hey, you stupid lady, you should have replaced me last month when I reached six months old.”

Dexcom RIP_ColorBecause I did not have time to replace the transmitter before I went on vacation, I left my Dexcom home.  The first night in a strange condo in another country, I woke up at 2:00 AM with a BG of 37.  Oh yes, there is a reason that I use a CGM.  I hadn’t seen a BG in the 30’s in months.  That’s how good my Dexcom G4 is at doing its job.

On one hand, it was probably fine that I was without my G4 on this vacation.  We were at the beach with water activities from dawn to dusk. It was likely that I would have forgotten my non-waterproof G4 receiver in my pocket and ruined it in the ocean or pool.  But I did miss the early warnings of highs and lows that the G4 provides me.

The morning after I returned from vacation, I contacted Dexcom and Edgepark to order my new transmitter.  No, actually it was a whole new Dexcom G4 system because I was  out of warranty.

I want you to take away two things from this post.

First, you might not get much warning that your transmitter is going bad.  If you are past six months, order the new one so that you will not have the two-week delay that I had in getting my new transmitter.

Secondly and very importantly, if you paid for the upgrade to the Dexcom G4 out-of-pocket, know that your warranty only goes to the date that your 7+ system was warrantied for.  It is not based on the date you purchased your G4.  For me, my Dexcom 7+ had been replaced in June 2012.  I paid out-of-pocket for the upgrade to the G4 in November 2012.  So my warranty expiration happened in June, not November.

I am lucky that I have good insurance and I have had very good results working with Edgepark.  I know that some people will carry their hate of Edgepark to their grave, but they have always provided me with excellent service. I called Edgepark the day after I got home from vacation and had the new Dexcom system in hand 5 days later.

My pockets are full again.  My pump in my left pocket.  My glucose tabs are in the leg pocket of my cargo pants.  My Dexcom G4 is in my right pocket.  And phone, you’re back in the purse because I have no pockets left!