Friday Five: WTF Happened This Week?

It’s Friday y’all. So much happened this last week that didn’t involve a certain reality TV star getting the GOP nomination. Here are some of the highlights and things to look forward to.

  1. United Healthcare teams up with Medtronic to only offer their insulin pumps and supplies to their subscribers. The Diabetic Online Community is buzzing about this. There is a lot of GOOD commentary about why this is a strange and somewhat scary decision and how all of this effects PWDs. Especially for the future of finding better care and solutions to simply exist as a normal person. I’m not going to throw more opinions out there since I’m still trying to formulate my own, but here are some  links/blogs to check out to get a background:
    Storyfy – the series of tweets, Facebook posts, and other social media tidbits from all parties involved to get the gist of the story from a facts perspective.
    How is Milk like Insulin Pumps? – Christel/ThePerfectD’s analysis of what this means in a real-world example.
    Choice is Necessary – Stephen/Happy Medium’s thoughts on the new relationship and how this helps showcase their parent company’s mission statement. (Spoiler alert: it doesn’t.)
    I Could Be Mad – Test Guess and Go’s feelings are similar to mine and I share a lot of Laddie’s thoughts. This one hit home.
    A Chain of Thoughts – Scott/Rolling in the D doesn’t post as often anymore, but I wish he would. I agree with him on the call for government oversight to end insurance companies acting like medical professionals. I also wish to use this post to squash fear that Big Government Run Health Care will act as a “Big Brother,” collecting and storing your data, so you may or may not get the care you need. Hello! This already happens in the private sector.


  2. Along these lines of healthcare, my podcast addiction, Pantsuit Politics, is actually covering the Affordable Healthcare Act next week. Between all of my Bernie Sanders friends touting  universal, single-payer, healthcare vs. my conservative friends pushing for the return to the free market for health insurance, I’m actually really anxious to hear what the hostesses have to say in their analysis. Given that this topic is hot and constantly thrown in my face, I’m struggling to figure out what the hell I want in my ideal healthcare system. Currently, the ACA IS my ideal choice, pending it actually worked properly. (Yay, public sector technology!) It’s a faux free market, which allows me to shop for a plan with a pre-existing condition, but I still (for now) can get a plan which will cover a multitude of diabetes durable medical equipment based on what my priorities are. (E.G. do I want one option for my insulin pump supplier at 100% coverage, or can I managed 80% coverage but switch pump companies as I choose?)
    Anyway, Beth, the conservative leaning hostess, posted a Primer on the ACA in preparation for Tuesday’s podcast. You can check it out for a very brief overview.


  3. It’s Spring Show Week! Quite possibly, my last Spring Show in a pro-am partnership since my instructor is moving across the country this summer. But, I’m not saying this is DEFINITELY my last showcase, because I said that one year and it didn’t actually happen. Anyway, I ran into another PWD performer during dress rehearsal. Meeting dancers with Type 1 diabetes is a rare occurrence – meeting them at your studio’s showcase is probably a 1 in 1 million shot. But, there we were, discussing where we could possibly put insulin pumps while wearing spandex and then performing.

  4. Capsule Wardrobe Related. Yes – I still have a small-ish selection of clothes to chose from in the morning and still plan on maintaining it for the remainder of the year. There have been a few hiccups lately when I realized that I didn’t keep a lot of my sparkly, trendy items in my ballroom costume bin, which probably would have helped when I was figuring out an alternative costume for my Spring show piece. (I didn’t need it, but I would have liked the option.) But I’ve moved from keeping only a certain number of items in my closet at once to making sure that what I have in my closet actually works, and that new pieces I purchase are from places with good sustainability practices. (And that my discards get recycled rather than tossed out.)

    I have been following a group on Facebook that focuses on Ethical Shopping . I don’t think I have the lifestyle (or the size) to dive into that kind of shopping head first. (Especially when simple t-shirts can cost $18+ and I have a messy toddler.) But, I figure I can do what I can by seeking out USA made items, or supporting a local business (part of the reason why I like Golden Tote so much). Second hand shopping online is super cheap and easy. And, I’ve reached a point where I don’t feel like I NEED anything in my closet – at least until the weather changes again. So – no shopping equals more money in my pocket for our vacation in November. Win win.


  5. Happy Mother’s Day! Which is Sunday, by the way. Make sure you call your mom, your grandma, or other maternal/parental figure this weekend to say “you’re awesome!”

Thoughts On the Ping Demo

I was reminded that I haven’t actually posted my thoughts on the Ping after I demo’d it on Monday. So here we go…

First things first – if you are in the market for a new device, ask for a demo! I don’t care if your insurance obligates you to only sign up for one specific brand because THAT’S who they want to cover the expenses for. You should have some knowledge of what you are getting into before you sign on for four years. After all, it’ll be at your side (or in your pocket, or bra, or whatever) 24/7/365. I was shocked, (beyond shocked actually), after the Lifescan rep told me she’s met with existing pump users for demos who didn’t know where their settings were. (Or couldn’t change them for that matter.)

Okay – enough of that.

So the meeting was about 1 1/2 hours of questions, conversation, and a little bit of hands on work. The Animas rep is a PWD himself who wore Medtronic for years before switching because his job said to. (Obviously.)

His initial impressions after switching were that his BGs ended up better on the Animas pump than on the Medtronic pumps – more notably during fastings and overnights when it’s only the basals being pushed through. Apparently, Animas Pings push out an increment of your basal rate for the hour every three minutes, whereas Medtronic has a tendency to dump a lot or a little during the course of an hour. Makes sense if you disconnect from the pump during a basal dump and you see higher sugars because you missed part of the dose. Hmm. YDMV… a lot, however.

I got to “play” with a test pump and the coordinating meter. My first impression? There is a LOT of information on that screen and it’s all really small and compact. The graphic designer in me wanted to adjust the leading really bad. I mean, I have decent eyesight for the most part, but much, much different than the big ol’ numbers of my Medtronic pump. It’ll take an adjustment to get used to it. Though – having it glow in the dark without a back light might be handy… unless my dress is sheer. (More on that later.)

The infusion sets come in self-contained inserters, so no extra plungers or devices to purchase to make site changes more efficient. The boxes everything came in are much smaller, so I might have more closet space one day. The infusion sites also appeared smaller and thinner than my QuickSets.

I got to play with the pump itself more. The scrolling through the numbers didn’t annoy me like I thought it would, but I could see breezing through your desired amount of insulin without thinking about it. Animas rep said he eventually figured out the “right touch” to scroll effectively… whatever that means. Maybe it’s like when you get a new touch screen cell phone and it has to get used to your touch? Although, to be fair, I’ve had instances with my Medtronic where I’ve suddenly scrolled up to 150 carbs when I meant to give for 50. It happens.

The bolus scrolling after you’ve decided that you need a dose seems a bit redundant. Why can’t it just auto-fill? Did Medtronic claim that as well? Seems silly. Animas rep said it has held him more accountable for doses. (The next generation will ask you, “Are You SURE You Want to Give 14 Units of Insulin?!” Just kidding… sort of. You just wait.)

Then it started to sing to me. No, seriously. I hit a button during the bolus administration (which was set HELLA FAST) and it started playing Für Elise a la a 1999 Nokia cell phone. DaHell? Animas rep: “Oh, you can pick the alert tones.” Seriously? I’m undecided if I like this. On one hand, I have the option of picking something I can actually HEAR. On the other, I’m going to drive my dance instructor mad! Anyway…

The reason Beethoven started playing? I cancelled the bolus delivery by accident. (More likely: I just hit a bunch of buttons after I said “Go!” and it stopped everything.) I think a review I read before the demo indicated that it was really easy to cancel a bolus on the Ping – now I see why.

Back to the sheer dress comment. The Animas rep mentioned that some of the women he has either trained or sold the pumps to come back and mention that the light up screen takes some getting used to if you hide the pump “with the girls.” As convenient as the meter remote is, the pump still lights up when a bolus is administered regardless of how. So for those ladies that stick their pumps down their shirts for whatever reason, sometimes they end up with an “Iron Man” effect if the buttons are facing out. Yikes. Something to think about as I often hide my pump under dresses in spaces I don’t want lit up. For goodness sake… how embarrassing.

On the flip side, the pump is WATERPROOF, and therefore sweat-proof. So I won’t be able to drown my pump as easily, like I have my Medtronic.

So is there a verdict? Not really sure yet. Could I live with this pump if I had a gun to my head and had to pick something now? Probably. I think there will be things I miss by switching from the Medtronic, but I may not have a choice if I can’t get a Revel. Hmph.

Narrowing the Options

It’s a slow day at the office, so I’ve been using my time to research/read up on the Animas Ping and any additional information I can get on the 530G. (Because their specs aren’t on the interwebz ANYWHERE!)

Don’t get me wrong. I like the t:slim idea still, but realized that while it has a 300 unit capacity insulin cartridge, I don’t go through that much insulin ever. I mean – I might whenever the pregnancy fairy grants my wish, but really? I barely use up my 200 unit cartridges in the three days I’m allotted. So – I’m less enthusiastic about the t:slim until I do more research/ask for a demo. Which leaves me with the unresearched Ping and Medtronic.

My biggest question lately has been the ability to do tiny ratios for boluses. I thought I heard about pumps getting down into the .5:1 range. (Apparently, that is just the UK’s Animas Vibe…) I’d love that option to get that low. I’m already on a 1:5 carb ratio for a majority of the day before pregnancy. Something tells me a 1:1 still won’t be enough in my 3rd trimester. (Though – the thought of giving 30 units of insulin to cover 30 grams of carbs is rather frightening… and a very real possibility.)

I began to look up 530G reviews and stumbled upon this article from D-Mine, which was written shortly after the press release was distributed for the 530G.

A few things struck me as alarming:

“This got me thinking: Could I just get a new Medtronic pump itself?

I picked up my phone and called Medtronic to ask about buying a new pump. Two different reps in the course of an hour told me the same thing: No, I can no longer just order a stand-alone pump. My insurance now REQUIRES me to get the newest device

So short answer: No, I cannot get a stand-alone Medtronic pump to use with my Dexcom G4.”

Seeing how I just asked for a prescription for a Dexcom G4 YESTERDAY, I got a little nervous. So – is Medtronic off the table completely now? (Because – why on earth would I pay for two CGM systems?)

On my lunch break, I called Medtronic myself and asked if the Revel pumps would still be made available to those who didn’t want the 530G. She told me it depended on my insurance and if they covered CGMs. (Which answered my question about Kaiser was going to deal with this because they don’t cover CGMs for anyone unless you are deemed “brittle.”) I said my insurance covers your current CGM just fine, but I didn’t really want to upgrade to the 530G; just the Revel. She said I could “request” the Revel if I wanted to, but it would just depend on if it got approved or not. (Approved by who?) The approval process would take the same amount of time as it would to request approval for a 530G, which was 5-7 days. Makes you wonder what the approval checklist looks like. (And do they decline requests without reason other than your insurance will cover the new model so that’s what you should get?) The whole thing seems a bit odd, but it sounds like they’ve updated their reps’ telephone manuals from the time that D-Mine article was written.

So – the Revel is still a possibility? Maybe?

More on the Ping tomorrow.

Ugh

Yeah, that’s pretty much my feeling this gloomy, Monday morning. I’ve now officially had a cold for the greater part of the last 30 days, taking a slight break for the Christmas holiday. But only barely. It’d all be fine if I couldn’t hear myself talk through the congestion in my ears.

Somehow, I did find time (albeit just a bit) to rest over the weekend and attempt to rid myself of whatever is lingering around. But, couldn’t resist trying to ballroom social dance for two hours straight on Saturday for the first time in… well, a really long time. (West Coast Swing is different.) But here we are, Monday morning, and I’m still supporting myself up with Sudafed, water, and hot tea.

My blood sugars have taken a turn for the unpredictable as since I’m sick, not dancing as consistently (or doing any exercise for that matter), and am now sitting in the last week and a half of my cycle. (At the very least, the ovulation monitor can give me some sort of idea of when my blood sugars are going to go to crap each month. The insulin resistance and odd-ball-ness seems to correlate with the new hormones. YDMV.) Guess we’ll see if the monitor was accurate at all.

Other things I learned this weekend:
– It’s not a great idea to rip out a Sure-T like you would a QuickSet infusion set. Ouch. The site still stings.
– The computers in my house are too new to support the Carelink Software. :-/ Yeah – that’s right. I bought myself a shiny new MacBook right around the holiday to replace my seven year old one. But – the Carelink software doesn’t recognize OSX 10.9! (Or Google Chrome… or newer versions of Firefox… ugh!) Since we’re predominantly a Linux household, there is no incentive to continue using Medtronic unless I want to fire up our old, finicky Windows machine. Not saying I won’t upgrade to a 530G in February, but the “doctor reporting” software that I might miss by leaving the company just became a moot point.
– The most accurate place for those Minimed sensors are the sides of my hips. In fact, I now have all sorts of fun marks there from being repeatedly stabbed with giant needles. Not really sure how to alleviate the scarring.

Lastly, the blog has a new look. It’s a bit too pink for my liking and I haven’t really given any thought to the one thing I can customize – the graphic in the side bar. (ANYTHING will be better than what it was. Yikes!)

/random

Episode I: The Phantom Bolus

Don’t worry – Jar Jar won’t be making an appearance. But this pump quirk is probably just as scary… or annoying.

This was my early Sunday morning…

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I treated an awful 46 mg/dl at around 5:30 am with a crap ton of juice and a graham cracker. I didn’t offer a bolus for the extra snack because I was exhausted and just didn’t care at that point. I’d just deal with it in morning. I didn’t have my transmitter on, so I wanted to take advantage of this uninterrupted sleep for the next couple hours.

I woke up about an hour and a half later because the cats were going crazy. I figured then would be a good time to check again and assess the damage. 192 mg/dl. Not great, but not horrible. Especially for a BG in the 40s. I go to administer a correction for the 192, which should have popped up a 2 unit correction bolus, at least.

It told me to administer .7 units. What?

It also told me that I had 1.3 units already in my system. WHAT?

I scroll to my bolus history and find the following:

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So about an hour after my low, I administered a 1.3 unit bolus for a blood sugar of 164. Which I don’t have record of on my meter. And 164 is a pretty specific blood sugar, so it’s not like I was like oh – I accidentally rolled over onto my bolus button and hit the up arrows. I would have physically had to enter that number in.

Did I just sleep bolus? Did this randomly just show up on my history? Why would I still be 192 a half hour later?

So I did something even more stupid and gave another unit of insulin because I was convinced that I didn’t actually get the full correction that I needed.

And apparently, I didn’t because I woke up about 2.5 hours later with a BG of 99. Excellent.

But – um. WTF?

Upgrade?!

This could be my future, very soon. (In purple, of course.)

During a routine supply order call to Medtronic, I found out my warranty date is coming up quick on my lowly Paradigm. (I say lowly just because Medtronic has released 2-3 new models since I upgraded last time and my doctors all keep referencing features on the new shiny models, but then are sad when they realize I can’t help them with my care without these features. Bah!)

So I figured… I’m on the phone with them right now, might as well figure out what I can do with that pending warranty date.

I have two options:

1) Upgrade now and pay Medtronic’s early upgrade fee of $800. (!!!) Get said shiny new pump with bells, whistles (literally), and re-order brand new stinking sensors, which apparently don’t look like evil hummingbirds nor hurt like hell going in. (But – apparently, I can keep my transmitter.) No insurance prompting necessary. This is Medtronic’s gift to you. (Merry Xmas and crap.) My warranty date, however, stays the same. (Which I don’t understand…)

2) Wait three months and have the insurance pick up part of the tab… which would be 80% of a $5000 device. Hi – you do the math. Option 1 is much cheaper. Well, sort of. However, I guess Medtronic also has other payment credit options, blah blah blah.

Secret option 3: I do nothing and carry on with my old school device because I’m going to end up paying through the nose on either option. (Or blowing my entire allotted FSA for 2014 in one order.)

Decisions, decisions.

#WW: A “Sure-T”hing?

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I’m not sure yet. This is the 2nd Sure-T set I’ve tried. But so far, so good-ish.

My CDE was concerned that my odd blood sugar readings in the evenings (when I dance) are possibly attributed to my usual sets, the Quick Set, either slipping out of place during activity (causing highs) or squeezing out too much insulin (causing lows.) Plus, the real estate around my stomach is not very adequate, so I was sent samples.

The Sils I haven’t touched yet – mostly because they freak.me.out. And you’d think that having a thumb tack size needle in you 24/7 would be horrible too.

Sans the mild discomfort in the first few hours, I don’t really notice it. In fact, they are bit nicer because the set is FLAT (or close to it). So there aren’t any awkward bumps under my shirts to explain.

Blood sugar control wise? Hard to say yet. My Monday morning and most of the afternoon was a straight, uneventful line on the CGM. And it was accurate. However, I’m still having weirdness at night that can’t be pinpointed to anything.

Well, hm, that wasn’t Wordless at all…

Dropped

A particularly appropriate title to encompass a number of things.

– I have not dropped off the planet, but keeping up with the blog has definitely dropped off my priority list. Lately, my topic ideas have been circulating around the new health care laws and how it’ll effect me personally. However, I’ve got enough politics floating around on my Facebook wall as it is –  involving close friends. I don’t need to invite strangers to the party as well. But I have to note that I started this blog about a year ago and I’m still thrilled when I get comments from y’all. Maybe now that conference season is ending here soon, I’ll have more time to write.

– I headed out to a super fun convention for a day and a half, which was much more than I expected because I thought I would be working all weekend. So I attended as a relaxed social dancer and cheerleader to my friends. It was quite nice. One of my friends insisted on carrying me on to the dance floor to a safe spot and goofing off. He lead me through a rather stomach-churning drop safely (because he’s twice my size), however, my pump managed to fall out of my pocket mid-trick and I had to fish for it with the tubing. Ouch. Mental note – clip the pump to the pants next time.

– My blood sugars have risen to sky high levels (for me)… and have just stayed there. I get so frustrated with the resistance and the micro-boluses I have to administer every 30 minutes that I usually just give up hope and over-correct…. THEN I drop. A lot. My CDE is considering having my try out a different infusion set, as my extended highs seem to occur right before a set change. (Nevermind that I usually change my site if I can’t get the sugars to come down over an extended period of time anyway…) She brought up using the Silhouette. I already hate inserting the sensors of death in at a 45 degree angle. Why the hell would I want to do that for infusion sets too? However, I only seem to be shrinking in my ab area (yay?) thus exposing the years of built up scar tissue in that area. I dunno…

Happy-ish Monday.

Mixed Bag of Stuff

Updates! Updates! Lots of little things to keep my Thursday going. I could wait until Friday Five… but. Eh.

MRI results are in. I have a clean noggin sans two small blood vessels near my trigeminal nerve in my head. I assume that since they made a note of it that they aren’t supposed to be there. Why they would be there and I’d only have a problem with them now is beyond me. I asked for a neurology referral even though my primary care doc wants to see me now for the same issue too. (The doc I was seeing was a sub.) I told her no, I’m not missing work for the fourth time to talk about the same symptoms I’ve been having for 3 weeks that need a specialist. Call me. Or hell… talk to your substitute! Read the doctor notes. It’d be a waste of everyone’s time. And money. And gas. I see an ENT in a few weeks as well. But no TMJ that my dentist could see and no Neurolgia. And no tumors. Hey!

 

So I finally got the Medtronic notice for the product recall. Apparently I had been sent at least one box of faulty reservoirs and they asked me to dispose of them. Apparently, I’ve already used them because I don’t have that Lot # in my closet o’ supplies. Oops.

 

Next week, we release a bunch of information about our dance studio. As an employee, I know a bit more than my cohorts and I hate keeping secrets. But – only for another week. What’s been released is that 1) I can still work there beyond August and 2) the programs are continuing in some way shape and form, so I can still dance there.

 

In two weeks, I compete at IGB in the Bay Area. I signed up for my usuals, but added in a multi-dance option at a fairly high level. I’m prepping to get my ass handed to me on a silver platter because my division will feature all dancers under the age of 49 at my level. (Or older if they want a warm up.) I have to keep reminding myself that I’m doing this for myself and not for fame and glory or money and medals. Though – the added competition, no matter how ridiculous it is, will in theory make me work harder so I get noticed.

 

Speaking of IGB, apparently The Learning Channel (TLC) is filming the competition and has an open casting call to all amateur competitors. Originally, I thought this was a documentary on ballroom competitions that would follow the pro-am partnership in great detail. But then again, based on the casting call that asked for “hot and sexy dancers who do anything to win,” I had my doubts. Still – since I have a unique story angle and I’m three thoughts short of rhinestoning my insulin pump – I was going to subject myself to casting. However – more internet searches gave me more information. It’s not a documentary… it’s a reality show slated for their fall lineup with six episodes planned. And since reality shows only seem to showcase the crazy, I can only imagine this train wreck looking like a cross between Honey Boo Boo and Real Housewives of New Jersey. I think I’ll just watch instead. Check out Ballroom Blitz in the Fall if you can. Maybe you’ll catch my blurred out face in the background… ha!

 

Enjoy your Thursday. Or what’s left of it.