The “Not-Quite” Threshold

As much as I love having the technology we do these days, such as continuous glucose monitors that alert me when my blood sugar is out of range, it’s issues like this that make me question, why bother.

I present, the Not-Quite Threshold.

I have my high alarm set for 180 mg/dl. It’s high enough that I don’t experience alarm fatigue, but low enough that I could stop a rising high before it gets out of control. Usually after a large meal or a low treatment.

I had a minor hypo at around midnight. I probably wouldn’t really treat a 70 mg/dl with a full box of juice, but I didn’t want to deal with waking up AGAIN to continue to treat a low. So I had most of a juice box, around 22 grams of carbs, and went back to sleep. Blood sugar shot up to about 175 mg/dl. And stayed there until I woke up in the morning at 5:30 am.

Just under my threshold to wake me up again and correct the overtreatment and wake up with a semi-decent blood sugar.

But according to my Dexcom, my sugars were still in range so there was no need to alarm, even though I really wanted it to do so.

I’ve since lowered my high threshold to 170 mg/ml; hopeful that I will be woken up by these minor highs more often and lowering my average. Because it’s the stuff like this that is kicking my A1c in the ass.

Also waking up hungry and not being able to eat is frustrating.

Dizzy, Spinning, and 54

Unhelpful Dexcom - SeeJenDance
If you are a PWD and haven’t heard of Kerri at SUM, I sincerely question your Googling skills. I catch a lot of her posts on Facebook and she re-shared a blog post today from 2012 that stopped me on my too-short of a lunch break.

The post was titled, Lows in Public – a phenomenon I’m all too familiar with. Especially as a dancer and someone who just enjoys a night out. The example of stumbling off to the bar asking for a cup of “just orange juice, please” is a scene I’ve played out several times. (Though, sometimes it is a regular Coke, or gah, a Red Bull.)

Kerri is correct, though. There isn’t ever a convenient time for a low. Especially one that leaves you with your mouth dry, the room spinning, your limbs shaking, and the desire to eat the entire contents of your pantry.

While dancing, or during any sort of exercise, things escalate quickly. It’s easy to get lost in the music or entranced by the power of a great lead. So the usual telltale signs of a problem aren’t generally noticed. That is, until your ability to communicate the partner dance basics – frame and connection – become frail, disjointed, and those turns take way more out of you than normal.

In a lesson setting, these lows also effect my ability to process any information, no matter how mundane. I’m easily frustrated. My ability to speak is labored and my eyes glaze over or blur. My teachers are pretty aware of when something is wrong, and understanding if I need to take a break. “It’s cool, Jen, just wait it out. I’ll explain something/choreograph/do something that doesn’t involve thinking for 10 minutes.” But, have I finished out a lesson while ignoring my symptoms? Yes. More than a few times.

The frustrating part of it all is that I want to keep going. I don’t want to randomly stop a social dance and awkwardly exit stage left. Usually, if I’m dancing with a stranger, I can’t give a two second speech on why I’m suddenly hungry and need to get off the floor. But man, if I’m 54 mg/dl, and there are two minutes long left on that song, it’s the longest two minutes ever and I’m hoping that I can remain upright. (Because, well, passing out is probably equally awkward.) And the dance just goes downhill from there.

Or the lows that creep up when I need to leave my house and drive to a private lesson. They are usually the ones that stick with me. The ones that take about 3 treatments before 50 turns into 60… and then turn to 240 an hour later. I have treated and just made the drive before. It is never a great decision if I’m still recovering from the lingering low feelings beyond when the latest test is back at a safe level. (Adrenaline is a bitch sometimes.)

Classes tend to be easier to escape, unless it’s short on followers. And then I get the guilt of putting the effort into making it out to class only to be sidelined for 1/2 of it. Why won’t these glucose tabs work faster again?

Between cutting a dance short or interrupting a Master teacher mid-thought, diabetes is the bane of social dance etiquette. It’s already an inconvenience for me; why should it be an inconvenience for someone else (well, the passing out thing… again)? My thought is if I can just push through it with semi-consciousness, I don’t have to feel even more helpless than I already do. Where I have to succumb to the inconveniences of hypoglycemia and I can no longer pretend to be normal.

Friday Five: Busy Weekend Edition

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I realize I haven’t done a Friday Five in a LONG time. This week in summary…


1.| So this happened.

Don’t get me wrong. I love my Dexy. Except when it doesn’t work. At all. Clearly, Dexy enjoyed too many St. Patrick’s Day Green Beers a day early. (I removed it and enjoyed too many Irish Shortbread cookies without it screaming at me.)


2.| My monthly Stitch Fix, Golden Tote shipment, and Trunk Club trunk are ALL coming at the same damn time. Fantastic timing, because I’m supposed to be figuring out my seasonal wardrobe around now. I might write summaries about all three of them in one post rather than individually. Because, tired. And Fuller House is on Netflix. (Priorities!)


3.| I’ve never really taken an interest in politics until recently. Maybe it’s the whole, being a staff member under a lobbying firm thing. I can’t make sense of the circus, even being a left-leaning centrist who prefers science over woo. A friend of mine recommended a Podcast that has been helping guide her in discussions. It’s Pantsuit Politics – or a conversation between two female friends with different political views. Their podcast began last November, but they’ve been covering more and more of the election process. (Because even they admit, they can’t escape it.) But it’s just refreshing to hear both perspectives of the political spectrum without all of the Facebook drama and subsequent unfriending. (Speaking of, post-Primary, I may retreat to Instagram. This is getting ugly, y’all.)

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4.| I’m ridiculously excited for some time to be an adult this weekend. It’s been far too long. M and I got tickets to a local craft beer festival and we’re seeing “The Book of Mormon” as well. Sitters (and grandma) are all lined up to watch Bean. The sad part was finding out how out of touch from the local scene we are. I don’t know if we ever really were in tune with it, but now we’re so far gone, it’s analog. Thank God I have savvy friends who can tell me what’s happening.


5.| I used my travel time last week to start (and finish) listening to an audiobook for the first time. I had 6 hours, one way, to kill, so I figured I’d try it. One thing is for sure – the new Apple earbuds are NOT made for extended wear. And, Girl on the Train was a really depressing read. But I’ll give myself kudos for picking it up before it was released as a movie.

 

 

Share and Share Alike

Blood sugar sharing – there’s an app for that.

This might be my only motivation to get an Apple Watch. Curses Steve Jobs and all your iMadness.

M is awaiting the release of the Android version, because I’m the only iDiabetic in the family. (If there are any hacks available that won’t void my warranty, please pass them along.)

Ignorance is Not Really Bliss

So hey… so much for getting back into blogging after DBlogWeek. Oh well. I’ve been busy buying baby things and reading and counting summersaults in my lower abdomen. But I figure I better check in.

I’ve become incredibly dependent on my Dexcom since becoming pregnant. Dex wakes me up in a timely manner for those middle of the night lows and probably saved me a lot of trouble in DKA-ville two weeks ago when my site went bad. (Got to see Labor and Delivery for the first time… but I don’t recommend doing that to see it sooner.)

Like most PWDs, I order my durable medical supplies from the a 3rd party distributor rather than the vendor itself. (Medtronic seems to be the exception to the rule, however.) So when I was taping on my last sensor in the box, I called my supplier to place a refill order. Supplier said no problem; we hang up the phone and I wait.

And wait. And wait.

A week passes and I don’t hear a peep from UPS, the supplier… nothing. So I call again before the holiday weekend and complain. The clerk apologizes, isn’t really sure what happened, makes sure I have a valid prescription, and sends my order through for approval again with an overnight delivery guarantee.

Holiday weekend comes and goes and nothing has been dropped on my doorstep by the time Tuesday afternoon rolls around. By this time, the tape on my two week+ old sensor has irritated my skin so bad that I’ve disconnected entirely. I call again. Different clerk takes my call and explains my order won’t go through because my doctor on file is located in Montana and I’m in California.

Wait, what?

I attempt to calmly explain that all they needed to do was pick up my order from March, which has the exact same information they need. The original prescription was authorized to give me a year’s worth of supplies, so what’s the problem. The clerk said she’d “leave notes” in my order. Sigh. I asked for a tracking number to be emailed me when the order was approved so I knew when it was done. Again… more notes.

Two more calls finally yield another promise to overnight the sensors to me on a Friday. This time, however, I did receive an email confirmation and tracking number. So I figured I’d be plugged in again very soon – which was great, because I was getting really sick of dropping into the 40s and not feeling a dang thing. (When the kid gets hungry, it eats all my food!) To counter my overnight lows, I woke up twice via alarm to test myself at my most common drop points. I was beginning to think how I survived 30 years without my CGM.

Saturday arrives and I check my tracking number, discovering the package has been delivered! Hooray! I run outside to discover an empty doorstep. Huh? Where are my sensors?

In the off chance that my sensors were delivered to my office building instead, how where they signed for and left at the “front desk” on a Saturday? The office building is closed and can only be accessed via key and UPS typically holds all packages until Monday.

On the phone with UPS now – discover the package was indeed delivered to my office building and signed for by someone I didn’t recognize. Great. Since I’m so desperate for my sensors by this point, I commute to my office. To my dismay, my package is no where to be found and none of the surrounding suites were open to even ask if someone maybe signed for the package and were holding it. So I reported the box lost and/or stolen with UPS but couldn’t get an investigation going until Monday morning.

I continued my weekend Dex-less and frustrated, especially since I saw more 40s and 30s than I wanted to. And when keeping your blood sugars in check is such a big deal as a pregnant woman, you seek comfort in seeing those straight lines and arrows on the Dex. There is only so much information to gain when checking your blood sugar via fingerstick every 2 hours. (Also – not efficient.)

Monday arrived and the package still wasn’t anywhere to be found. I needed to work off-site for the morning, so I alerted our admin to keep an eye out for UPS in case they dropped something by for me. I also got a call from UPS indicating they still had no idea where my package was.

Around 10 am, our admin sends me a text saying someone dropped by my package and it was on my desk. Was it UPS? No – it was dropped off by a woman in another suite who was working on Saturday and caught UPS as they were arriving, signed for the package and held it until today.

…Um.

Does anyone else see anything wrong with signing for a package that 1) doesn’t belong to you and 2) isn’t even going to your suite? Maybe not so much #1 in an office building, but still. Good samaritan or not – it would have saved me a lot of grief if the package was just held until Monday.

After all that madness, I’m finally plugged back in and feel better sleeping at night. Of course, today wasn’t without calibration errors and the three question marks of doom. But that seemed to be just misbehavior and not an indication of a bad sensor and site.

I guess from here on out, I need to order my sensors when I have two left in the box…

How Much Is Too Much Data?

I went to Sacramento’s version of TCOYD yesterday for the later part of the afternoon. (By the way, if there is one near you, I highly recommend going. It was only $20 and they feed you D-friendly catering with carb counts!) I was sitting in one of the forums on CGM technology and one of the questions asked stuck with me enough to break my blogging absence and write about it. (I promise… I have plenty to share… later.)

A CDE in the audience told the story of a patient who was diagnosed at the age of 8 and her parents put her on a Dexcom by the age of 10. From that point forward, the young D-ling obsesses over the spikes and valleys of her Dexcom graph; often sitting and waiting with a cup of juice in hand if her Dex showed a downward trend with a 120 mg/dl readout. “I know it’s coming!” the CDE repeated.

Panelists suggested the young patient wasn’t ready to have a CGM, especially if it was causing obsessive behavior. But I took to heart how many times I’ve checked my Dex in an hour while I was waiting for my high blood sugar to do something. Y’know, continue to elevate so I could justify a correction or see a downward trend so I can eat once more. And sometimes I become so obsessed with a stagnant high that I give up and correct anyway… which usually has detrimental results.

It’s very much like watching the Stock Exchange. If you’ve ever seen movies about Wall Street or watched brokers on the news shouting to “buy” or “sell” on the floor because people’s retirements are at stake… you know what I’m talking about. People can drive themselves nuts if they have a very aggressive portfolio to hopefully support their livelihood as an older adult. And then that fateful day comes when the market crashes and they lose everything. Gone. What now?

I can’t watch my portfolio… but I do study my Dex. Sometimes obsessively, and the consequences are a bit more extreme than losing your life savings. Especially now that my sugars have become more erratic.

On one hand, I’m lucky to have this technology at my fingertips. Last night, for example, Dex woke me up on 4 separate occasions for falling blood sugars. They were all legit… and sadly interrupted my already limited sleep. (Curse Daylight Saving Time!) But without Dex waking me up, would I have woken up myself? And when morning did come, I could see that this trend is becoming a regular occurrence, prompting me to reduce my carb ratio for my bedtime snack. (Never thought I’d ever see a 1:7.)

On the other, I find myself clutching my Dex for answers and finding frustration in the stable arrows. Yes – trending up or down arrows can mean trouble too, but those stable, do nothing, apathetic arrows really get to me. And I will hit that power button once… twice… four times… in one hour. Just waiting for it to do something. Am I really still 63 mg/dl and holding? Should I test AGAIN and treat? Or – it’s been two hours and I’m still holding steady at 180? Why won’t you start coming down?

So which is better? Is ignorance really bliss, leaving us powerless to our body’s trends? Or are we to take in as much data to educate ourselves, but while clutching a cup of juice and waiting?

PS: I did have a lot of fun at the conference. I got to meet Kerri, Chris, and Heather. And then listened to Manny and Adam (along with Kerri) give a real good push for the DOC and digital technology for diabetes. Way to go, y’all. And based upon all the photos that were taken of them, they are quite the celebrities. 🙂

First Day With Dex

This post has been sitting in my Drafts for about two weeks now. Work just hasn’t let me not work recently, and by the time I come home, I’m exhausted. Blogging smogging. But it’s “wordless Wednesday” still, and this post has lots of photos. But also lots of words.

So I named the new Dexcom “Dex” for obvious reasons.

Both seem to like blood.

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See what I mean? (That’s the calibration symbol by the way.)20140213-072925.jpg

Dex arrived on the 11th in its shiny box-ness. There were really detailed pictograms and instructions, but the supplier I purchased this all from said the YouTube tutorials was where it was at.

I have to admit I felt like something was missing – the sensor inserters! I was told everything was included, except for maybe the tape to keep the adhesive down. But MedT always made me buy some other Insertion device, so I got really confused. Turns out the sensors are all inclusive and the inserters are one-time use, disposable plungers, so to speak.

So after a quick couple views of the instructions and 2 viewings of the YouTube tutorial, I decided to place my first sensor. It was a little weird, but definitely NOT painful or jarring like the old Sof Sensors were. But I wanted to let the sensor marinate overnight, thinking I’d get a quicker calibration period like the MedTs do.

Apparently Dex’s don’t work like that. You need to wait the full two hours after you start a sensor, regardless if it’s been sitting in your system for 8 hours. Hmph. It didn’t do me much good because an hour and half into my sensor start, I got this.

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Apparently this is Dex’s “Sensor Error.” If you are a MedT user, you know these generally figure themselves out eventually. This did too.

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And we’re back to normal. Time for calibration! Naturally, I just wanted to finger-stick myself all day to check the accuracy. I couldn’t help it! However, my fingers probably wished I hadn’t.

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Not identical, but mostly in range.

Of course I was having a banner blood sugar day and I wanted to test the effectiveness of the sensor, so I gave it a test.

Dex… meet Red Velvet Macaroon.20140213-073021.jpg

Actually, it wasn’t really worth the carb counting, but I’ve never had one before, so why not. It didn’t come without debate because I’d been having a no-hitter for the last few hours. Why mess with it? Oh well.20140213-073035.jpg

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I did get a matchy some time after the macaroon! So that was exciting.

It’s not without it’s downfalls and quirks, however. While 95% of my low alarms have been legit, I still have trouble with CGMs recognizing how high I am. That was among my complaints with the Sof Sensors. The give and take accuracy was never giving and taking in the correct direction. I’ve had the same problem with the Dex.
20140213-073059.jpgAlso – that disclaimer about the Dex running higher than normal after you take Tylenol? Totally legit, which is kind of a bummer if I take something for a headache or cramps right before bed. (Guess I won’t be sleeping much tonight again.)

I also never really got a personalized phone call from Dexcom, the company, after I received my Dex. I got a RoboCall, telling me that if I had any additional questions, I should call their Help Line. Alright fine… but no account manager, no customer service reach out… nothing. I mean, I figured it out on my own, but I thought it was weird from a service stand point.

I’m on my second sensor. I tried to go beyond the 7 days on my first sensor like everyone else does, but I got more “???” signs, meaning my sensor was probably in a rough spot. (My stomach is never a good place for sensors.) The sensor in my hip seems to be working just fine.

I also don’t completely trust the Dex yet. In fact, it’s too the point where I’m checking so often, my CDE doesn’t need the Dexcom trending graphs to see what my blood sugars are doing every hour. Yes – my fingers are really sore.

Carrying two devices is also a little weird, but it’s got such a kick ass range, I don’t feel like I need to carry it around all the time in my pocket. It stays on my desk at work for reference and I’ll take it with me if I leave the office for an extended period of time. I set it on a table at the dance studio during a private lesson. It stays on my nightstand while I sleep.

So far, so good.

Still Here?

I am, I promise. Life just sort of happened.

My Dex is here and now has a shiny new purple Tallygear case! I have a whole post drafted from about a week ago with photos and thoughts and funny analogies. But the words are mostly still in my head and I haven’t had a chance to sit and write it all down. Since work has been sort of busy, I didn’t feel right typing away an ode to Dexcom and the new bulge sitting on my abdomen. Don’t get me wrong – I love the Dex’s accuracy, but the transmitter is ginormous.

And while I had every intention to write this weekend, I also competed at another west coast swing convention and won all the things. No – seriously. I placed in the top three in every contest I entered. (One had 60 entries!) That said, I’m now out of the Novice division and can start competing as an “Intermediate” dancer. And the prize money won reimbursed me for my convention pass. Score.

More soon. Stay awesome.

Medtronic: It’s Not You, It’s Me.

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Breaking up is never easy. But I have to say “so long” to my Medtronic CGM.

I took the plunge. Paperwork for a new Dexcom G4 CGM sensor system has been submitted to my doctor for approval.

I know – why not wait and see if you can just get the Medtronic Enlite system in February? Especially since you just ordered 3 months of Sof-Sensors… (I altered it today so that I just get 1 box while I wait for my new system to be approved.)

Look – I really wanted to like my Medtronic system. I gave it almost a year, and apparently the warranty only covers it for 6 months. (So – if I start seeing issues with it, I need to buy a brand new system anyway.) And I know my doc will be slightly disappointed that I won’t be using Carelink anymore. (I can’t really anymore anyway because of my computer issues.) But I can’t keep relying on the “direction of the sensor line, not the number in the sensor” if the sensor line doesn’t have a correct projected output.

Too many times, I’ve had a flat line sensor reading for HOURS, just under my threshold, only to discover I’ve been hanging out in the 250s for those hours. Or the double down arrows, dropping into the 50s, when I’m sitting comfortably in the 150s. (And rising.)

That kind of inaccuracy makes me really nervous when it comes to SHUTTING MY PUMP OFF IF I MISS AN ALARM! I’ve been woken up by many-a low alarm in the middle of the night. They are generally legit, but not always. So if my sensor is having a rough time, drops me to under 70 while I’m asleep when I’m really not… yeah, no.

Sure – Dexcom has its issues too. (They all do… we’re trying to re-create the functions of a dead organ with our best guestimates.) But, I need to try something else. For everyone’s sake.