Tuesday, March 8, 2016

I'm Moving this Blog... So Please Stay Tuned.

I've wanted to write here on MyT1Diabetes several times lately-- but I'm waiting. 

For some reason, it became important for me to get a domain rather than just writing here on this Blogger site.   A Domain.  My domain.  That sounds so legit. And I really want to be legit.

I'm giving myself about a week to get it up and running, but I'm telling myself the bells and whistles aren't important.  Because they aren't... right?!  I don't want to get bogged down with that.  I just want to write my posts, and I want to get other people piping in whenever they feel so inclined!  That's all!

I'll be sure to but the "I Have Moved" sign here once it's ready for readers.  For now, I just wanted to explain why I haven't posted in the past couple of weeks.  It's about to get REAL.  So hang tight please.

Tuesday, February 23, 2016

How Accurate is My Blood Sugar Meter?

I often read other Type 1s comments about the “inaccuracy” of the readings on their Dexcom. But surprisingly, I don’t see all that much complaining about the inaccuracy of their blood sugar meters.

When using a Dexcom, you're suppose to calibrate it two times a day using data from a blood sugar meter, a.k.a, a glucometer. I sometimes get a meter reading that’s way off of what the Dexcom is saying.  When I get a surprising result, I’ll retest, and many times, I get a completely different reading from my meter the 2nd time around. Often it’s the Dexcom that’s right, and the meter that gave me a false number.
WE NEED ACCURACY in our glucose meters AND Dexcom.
Before you even ask, let me answer that yes, I wash my hands prior to pricking my finger for a reading.  This, as you probably know, can make a huge, huge difference.  (I used to NOT know that, and maybe that explains some previously unexplained low blood sugars after taking insulin.

In Steven Ponder’s Sugar Surfing book, he wrote about the current FDA guidelines for glucometer accuracy.  I’m basically copying this from his book and it says:

If the actual BG value is over 75 mg/dL acceptable values from the meter could be 20 mg/dL above or below the actual value and it would still be acceptable. If the BG was under 75 mg/dL, the variance must be 15 mg/Dl.  Most shocking of all--- in 5% of the test cases, the value can deviate from the actual reading by ANY amount.

Wow. That is alarming. And seems like a very dangerous allowance!

Like I said, when the test number seems a little off to me, I retest again.  And sometimes, I test a 3rd time for my tie breaker.  This seems a little ridiculous, but I guess it’s the best we’ve got.  Like Dr. Ponder says in his book, "The reality is that commercial blood sugar meters provide estimates of blood sugar levels."

If we want accuracy with our Dexcom, it’s got to start with the glucose meter readings we get for the calibration. So, I’d like to find out what is the most accurate and precise meter.  I have a few different meter brands tucked away and hopefully I can round up some test strips for them and test them against each other.  It could make a difference in what test strips I ask my doctor to prescribe when I go in for my appointment next month.

I’d love to hear what meter you’re using and how you feel about the accuracy. 

Wednesday, January 20, 2016

Why I Still Love the Dexcom Receiver

One thing I thought was going to be great about the Dexcom G5 was that I could get all my blood sugar data delivered straight to my iPhone.  I wouldn't have to carry around my Dexcom receiver anymore.  That idea of having one less thing I would have to keep up with sounded great to me!  And although I knew with the G5, Dexcom would still send me a receiver, I figured I would put it away in a cabinet along with loads of other diabetic supplies and forget about it.

But as it turns out, I've been carrying around both the receiver and the iPhone. I'm a girl, so shoving things in my purse comes natural to me.  Sometimes it feels quicker to just pull out the Dexcom receiver and hit one button to see my trend graph. (It feels quicker, because it IS quicker.)  Also, if I'm at a movie theater, the screen of my iPhone is distractingly bright, where as the little receiver is less so.
Dexcom G5 Receiver
But unfortunately, I misplace that receiver very often.  Sometimes it's in a weird pocket in my purse, or in a pant pocket, or fallen in the crevice of a chair seat, or wherever... I waste way too much time looking for it. I have said at least a dozen times, "We'll, I guess this time it's gone for good." And then miraculously, it shows up.  I have now written my name and mobile number on the back of it in case a stranger ever comes upon it and doesn't know what it is or what to do with it.

So although I am often annoyed about not being able to find the little receiver, I prefer it over the iPhone app. And here is a little story to illustrate why.

I couldn't find my Dexcom receiver one morning as I was rushing out of the house on my way to yoga.  I looked around the house a bit, but didn't want to be late to class, so I went without it and just brought my iPhone inside the studio.

About 20 minutes into the class, I reached over to my iPhone to see how my blood sugars were doing.  AND THEN the teacher said -loud enough for the entire class to hear- "Uh, no. This is not the time to check your phone or start texting someone."  I'm sure I turned the color of a turnip.  It was rude of her for sure, but I was the one embarrassed.  Do I really seem like that much of an asshole that I would text in the middle of a yoga class?  I looked her, and I shook my head no, whispering , "I'm so sorry.  I wasn't texting though." She came closer to me and asked, "Oh, is that a heart rate monitor or something?" (As if it was really any of her business....) I told her I was diabetic and my phone has an app that shows my blood sugar.  She then said something that she thought made her look like she was being kind in her questioning, but I know better... She said, "Oh, see?  I need to know if you have a condition like that.  In case you ever get real thirsty in here, then I'll understand why and I'll know what to do."

"What?!" I wanted to say. "No.  I'm pretty sure you have no idea what I would need if I had a problem with my (thirst?!) blood sugar during class." But I just breathed in/sighed and did my downward dog pose instead.

Not only is this quick story that explains why I often prefer the Dexcom receiver over my iPhone, it's also an example of why having a Dexcom CGM is so important to me.  I don't want to ever have to rely on others to help me get out of a situation related to my diabetes.  Because they may just think I'm thirsty and pour water on me!

All I ask of you Dexcom is this: Can we please put a tracker on that receiver already?

Wednesday, January 6, 2016

My Switch To Tresiba Insulin

Although I once tried wearing a pump- for a DAY, years ago (that's a whole other blog post for another day!)- I've always been a diabetic who prefers multiple daily injections instead.  As you know, everybody's preferences are different.  For me, it's insulin shots all the way.  I'd rather take 15 shots a day than wear a pump.  As I've said to my doctors in the past, IF my blood sugars ever get way out of control, and I can't figure out a way to wrangle them in, I'd be willing to try a pump again.  But for now... MultipleDailyIinjections.

For years I've taken one shot of Lantas daily for my long acting insulin. Then throughout the day, before I eat a meal or a snack, I take short acting insulin.  That has worked pretty well for me, except I've noticed that although Lantas supposedly can last up to 24 hours, on me it definitely doesn't.  Or at least it doesn't work nearly as well for me during the last 6 hours or so of that 24 hour duration.  I've always just compensated by taking more short acting insulin during that time, as the long acting insulin was losing it's effectiveness.

Recently, a new long-acting insulin called Tresiba became available.  My doctor told me there isn't much of a peak, if any, and it lasts beyond 24 hours.  If you're a little late taking it, or even if you go to sleep and wake up the in the middle of the night and remember, "Oh shit!!! I forgot to take my shot before bed last night!" you can take it then.  (I've said that sentence plenty of times in my life, so...Whew!) In the information I read on the Tresiba website, it says basically that you're good to go as long as you have at least 8 hours between your doses. Yay! Sounds pretty friendly and flexible to me!

Tresiba Flex Touch Pen
If I understood what my doctor said correctly, it's the first insulin with a new molecular make up put out in a super long time. That sounds exciting, right?! He said I was a perfect candidate to take Tresiba.  That is because, first of all, I'm an MDI-er.  And because I don't require a whole lot of insulin generally speaking, so it all seems to clear out of my system pretty quickly.

Tresiba Insulin
Anyway, I've been using Tresiba now for nearly a month.  And it seems to be working well.  I have more predictable insulin needs throughout the second half of my day now.  Although I was told to take the same amount of Tresiba as I was taking with the Lantus, I've actually decreased my dosage from 12 units to 9 units. This may or may not be due to the insulin change...Every now and then, I make adjustments- gradually- with my long acting insulin.

It's approved for both Type 1 and Type 2 diabetics that take insulin. Anybody else out there using it? As always, I'd love to hear what you think...SO, if you have anything to add to this conversation, or any questions or whatever, please say it in the comments section. Please don't be shy! You make my blog so much better by sharing what you've got to say.

Tuesday, December 29, 2015

Sugar Surfing For Good Blood Sugar Control

I'm not a huge fan of carb counting and never have been.  Many years ago, when I was newly diagnosed with Type1, like all good diabetics do, I began weighing and measuring my food, figuring out the carbohydrate amount, and then dosing my insulin injections based on that. But at best, my carb counting has always felt like a guessing game. I can eat the exact same thing and have the exact same amount of insulin with great results one day, and repeat it on a different day with either high or low post meal blood sugars- Neither of which feels good at all.

Obviously, when I have low blood sugar, I have to react and treat it.  So although it feels awful, and is often embarrassing and a burden, it never stays low for an indefinite period of time.

But with high blood sugars... Well, I USE to just wait until my next meal to take a shot. In the past, I'd been told by my doctors to not stack insulin doses, and I was also told to only take insulin before eating a meal. I held on to those rules for many years.

Which means... I would have hours of high blood sugars when my insulin coverage wasn't enough.  But over the past year or so, I've learned by trial and error how to avoid staying in a high range for more than just a short amount of time.  On my best days, when I'm really on my A game, I can avoid those high blood sugars all together.

I still obviously sort of count carbs (I "eye-ball" things, but I don't weigh and measure), but I don't worry too much about being spot on with my calculations- I can make adjustments when I see my Dexcom CGM trend graph start to head in the wrong direction. Sometimes, like after eating a high protein meal, my blood sugar is fine the first few hours. But around 3-5 hours post meal, I get a little rise.  When I see that upward trend begin, I just take a little insulin to cover it.  And that line on my Dexcom that was rising, dips back down and straightens- right where I want it.

One day, I received an email from JDRF about an author coming to Dallas to talk about Sugar Surfing.  I had heard the term "Sugar Surfing" mentioned on a few Type 1 Facebook groups that I belong to.  I knew very little of what it was all about, but I knew it sounded like something I was interested in.  So I signed up for the event.

It was a very motivating presentation.  Dr. Ponder, who is an endocrinologist that has Type 1 himself, went over many graphs that explain how he uses his CGM to maintain tight blood sugar control.  He makes it easy to understand and also interesting.
Dr. Stephen W. Ponder at a "Sugar Surfing" talk in Dallas
He definitely motivated me to do a better job keeping track of what I do. Since attending his event, I've started using the Dexcom 5 app as a spot to quickly and easily record how much insulin I take and when I take it.  That way, if I've forgotten the amount or exactly when I last took a dose, it's all right there so I can easily take a look.

So the myth that stacking insulin, or taking insulin between meals is a bad thing is officially dispelled. Instead, it turns out to be a huge reason why my A1C is currently under 6%. And I plan on keeping it there, by the way!

And yes... I do run into low blood sugars a fair amount of time, but nothing overly dramatic.  In fact, often, I can just eat about 5-10 grams of carbs and I'm right back up in the 80s.

There's a Facebook group for Sugar Surfing you can check out.  Dr. Ponder posts tips, his CGM graphs, and mentions when he'll be out speaking about his Sugar Surfing book.  The talks he gives, by the way, are free of charge.  When I went to the one in Dallas, I intended to buy his book, but the line was pretty long and I had another meeting to get to. So instead, I went home and ordered it online from Amazon.
Sugar Surfing by Dr. Stephen W. Ponder

I haven't actually finished the book- but it's a great reference tool for how to use your CGM to tighten your blood sugar control.

Anytime I make changes in my plan for managing my blood sugar, I do it gradually.  That way, I'm not taking any big risks. I've learned that when I make drastic changes, it never seems to go over very well.  So, please...be safe! 

Now that many of us are lucky enough to have a CGM, we can manage our blood sugars so much more effectively.

Sunday, December 13, 2015

Getting the Most Out of My Dexcom CGM

Can I just say thank you so much, to all the nice people that read my last blog post and sent me supportive comments?!  That totally and completely made my day. And it was already an awesome day to begin with.

So, I definitely wanted to get started on sharing a few of the things I've done to get that A1C to my all time lowest- and best.  Like I mentioned in that last post, an A1C is just a number.  But all of us Type 1s care a lot about it!  We all want it as low as we can get it without having to suffer through a lot of low blood sugars.

My style of blogging, which I'm sure you've noticed if you've read a few previous posts, is to keep things pretty short and sweet.  So although I've got a whole list of things I've been implementing and unimplementing (that is a word I just made up, and obviously, it's meaning is: v. the opposite of implementing) I'll just focus on one thing at a time.

Today, I want to start with the biggest game changer that's come into my life over the past few years:
My Dexcom continuous glucose monitoring system.
Dexcom G4.  My first CGM.  And a total game changer for me.
It's been over 20 years since I was diagnosed with Type 1 diabetes.  So 20 years ago, I was on a big learning curve.  I read every book about Type 1 I could get my hands on.  And I went to a few (very depressing) "support group" meetings.  I learned as much as I could about my brand new disease from my doctors and those books. (Because the internet wasn't around back then!)

And then, once I got my blood sugars relatively under control, I just kept doing what I was doing.  I sort of forgot that new information was probably coming out all the time.  And because I've been coasting along, and doing okay with my blood sugar control over the years, my doctors sorta kept me on auto pilot.  For 20 freaking years.

But fortunately, I have a friend named Tanya, that also is a Type 1.  And she is constantly trying new things like pumps, and meters, and medications that other than through her, I never even would have heard about. To be honest, although I love hearing about anything she has told me, I personally didn't have a big interest in it for myself until she showed her Dexcom to me one night at dinner. My A1C had started slowly creeping up over the years- nothing super alarming, but getting to see a graph of my blood sugar over a 24 hour period sounded like something that would be helpful.

I didn't know if my insurance would cover such a thing, back when Dexcom was new on the scene.  I actually volunteered to be in a clinical trial in which I would've had to use a Dexcom, and would have gotten to keep it- that I didn't qualify for.  Boo hoo. But then I thought, "Hey, I should at least ask my insurance if they could help cover it."

As the saying goes, "Ask and you shall receive."  I asked and I got my first Dexcom free- well, technically, I had already met my deductible.  I think I had to pay 10% of the cost.  But it felt free enough, and I was very happy.

I thought I would just use my Dexcom here and there- like maybe one week every month or two, just to get an idea what my blood sugars were doing over a 24/7 period.  I also (wrongly) thought the big appeal of using a Dexcom was not having to prick my finger as often for a glucometer reading.

From Day 1 of inserting my first Dexcom sensor, I haven't gone a single day without it.  As advised by the Diabetic Educator that showed me the ropes so to speak, in the beginning, all I did was look at the trend graphs.

I just watched for a few weeks.  But then, once I understood a few things like how long it seemed to take my insulin to make a move on my blood sugar before a meal, and what my blood sugars were doing a couple of hours after eating and while I slept, I couldn't help but make changes.  Little ones at first.  And I got bolder and bolder with my insulin dosages as I became more knowledgeable based on the knowledge Dexcom gave me- Knowledge that I was never privy to before.  Now I don't just take shots before a meal or bedtime.  I will take small doses of insulin throughout the day when I notice it going too high.  I'm not at all scared of lows, because my doses are very small (1/2 unit doses with my insulin pen) and because I know the Dexcom will show me what's going on as my blood sugar is falling.  I can take a small amount of carbohydrate if necessary.
Dexcom G5 on the iPhone

So I have to say... Of all of the things that have allowed me to make a positive change in my overall diabetes care Dexcom is number 1.

It also piqued a whole new interest in this disease that I'm not sure I ever had, at least to this extent, before. Looking at my trend graph throughout the day is a huge motivator.  I can't help but react to the numbers.

I'm now using the Dexcom G5.  I like having it on my phone, but sometimes, I prefer the little meter Dexcom provides.  (If you're interested in my comparisons of the G4 and G5, I wrote a blog post about it, which you can read about by clicking right HERE.)

In my next post, I'll talk about Sugar Surfing, which is my other huge discovery as of late.  There's no way I could do "sugar surfing" without having the data that a Dexcom provides.

Thanks so much for reading my post today, and for visiting my blog.  Please leave a comment if you have anything at all to say and add to the conversation because that's what makes for a good blog, and I am sure aiming for having a great blog focused on Type 1!  Please don't be shy- I'd love to hear anything you have to say, and I'm sure other readers would as well.