Reviewing 2013 & Previewing 2014

2013 was a pretty big year for me, diabetes-wise. There were both literal and figurative highs and lows throughout the year. Let’s recap!

thumbsupdown2Highlights

– Starting the Dexcom G4 continuous glucose monitor in April

– Launching The Blood Sugar Whisperer in May

– Attending the American Association of Diabetes Educators conference in August

– Starting the Omnipod insulin pump in August after a 15 month pump hiatus

– Attending the Insulindependence day conference in October

– Writing articles for Insulin Nation and Type 2 Nation, and upcoming articles in Diabetic Living magazine and Diabetes Health magazine

– Meeting Jess in Boston in May, meeting Stephen in Philly in August, meeting Anna in Philly in August and meeting Laddie, Katie and Emily in Minnesota in December

– Successfully running five 5Ks and one 10K throughout the year

Lowlights

– Losing my Dexcom CGM in July and not being able to go on it again until October

– Losing my Dexcom CGM again on Christmas Eve — not one of my finer moments!

– Still not achieving an A1C under 7%

– Not losing any weight this year

– Not really working on my book (more on that later)

So, 8 in the highlights and 5 in the lowlights. Overall, a pretty decent year in my opinion!

~*~

We have a pretty exciting 2014 in store too! If you haven’t heard via Facebook, Twitter or my other personal blog, my husband and I are making the move to Minnesota! My husband is currently interviewing with a few different environmental consulting firms, and we plan to move fairly soon after he gets a job. So cross your fingers!

What does this mean for my education? Well, it’s changing again! I won’t be getting a Masters in Nutrition from Columbia University. Instead, I will be applying for a second Bachelors at the University of Minnesota. Because U of M has slightly different requirements from Columbia, I have yet more classes that I need to take before I can start my program. I’m telling you, I will be the most prepared Nutrition student the U has ever seen!

 

 

Omnipod: Your Questions, My Thoughts

omnipodfaqI have been on the Omnipod insulin pump for three months, and the question I get the most is “Do you still like it?” The answer? Yep! I still do!

But I get questions about Omnipod and I also see a lot of questions posted on Twitter and Facebook communities that I’m a part of that I thought I would answer directly here on my blog. If you’re thinking about switching pumps or fully committed to the one you’re on but just want to know more about my experience with the Omnipod, I hope this series of questions will help!

Is it comfortable to wear?

Probably my biggest concern — and the concern of others — is whether or not the Omnipod is comfortable to wear. Because it’s directly on the skin, as opposed to clipped to an article of clothing, it can look a little disconcerting. The Omnipod is also a lot bigger than your average pump set, although the new pods are not as big as a pump.

The Omnipod is about as comfortable as you can get. Obviously, with either tubing or a pod, you’re going to have some coming out of you that can get tugged, pulled, smacked, whatever. Diabetes medical devices are not the epitome of comfort or style. That being said, I rarely have an issue with where I place my pod. I have worn it on my lovehandles, my lower back, my thigh and my arm. My preference is my lower back. Out of sight, out of mind. Lovehandles don’t hurt at all, but you can see it more readily. You can barely see the pod on my thigh or my arm, but I feel it a bit more. The pod’s adhesive tugs a wee bit on my arm, and since I have muscular legs, I don’t really like have anything sitting there (I also don’t like my CGM there either).

What about tight-fitting clothes?

Yikes. You’re asking the wrong gal. I don’t wear tight-fitting clothes because I don’t have that kind of body. I would imagine that wearing the pump on your lower back would solve that problem, because the pod really won’t be see by anyone. Someone would really have to be looking hard at your backside!

I also like that I don’t have to physically bolus from the pump. The closest tubed pump that does this is the Animas, and that was my runner-up pump. But I prefer the Omnipod interface on the PDM more than the Animas pump, which was part of the deciding factor.

Don’t you hate carrying around an extra device?

I keep hearing this “extra device” business but there really isn’t one, because I don’t have a glucose meter anymore. I have the pod that’s on me, and the PDM that acts as the pump controller and my meter. Two things, just like tubed pumpers. The only thing is that you can still eat without having a meter, should you leave it at home. That’s definitely a con. I wish you could bolus from the pump in an emergency. That being said, you still get basal insulin when you are without your PDM.

However, I feel it necessary to mention that I have left my tubed insulin pump at home no fewer than five times in the 10+ years I was on Medtronic. I’ve also left the house with hardly any insulin in my pump on more than a few occasions. It can and does happen to people. Don’t think you’re immune to forgetting your pump and/or insulin just because you’re wearing a tubed pump.

Does it suck that you have to change the pod every 3 days?

Not really, because by the 3rd day, the pod is empty! An Omnipod only holds 200 units, and I go through that in about 2.5 days. Sometimes if I’m doing really great and not eating too many carbs, I can go all 72 hours before I have to change my pod. Plus, when the pod expires you actually have another 8 hours to change your pod. It doesn’t just deactivate. It gives you some buffer time. I have never wasted more than 5 or 10 units per pod.

Changing the pod is also pretty quick and easy, so I don’t mind doing it every couple days. If anything, I’m sure it helps keep my skin from scarring from all the rotating!

Aren’t you bummed that Omnipod isn’t working with Dexcom?

Yes. I’d be lying if I said I didn’t think that was tragic, but I’m trying to not focus on that right now. I love Dexcom and I really like the Omnipod. Right now, none of the approved pumps are connected to Dexcom and I have made it a rule never to make a decision based on technology that might eventually happen someday. I guess I’ve just been burned by Medtronic too many times. When it’s approved, then I’ll believe it. I don’t necessarily think I’ll be on Omnipod forever. At this point, unless I went with Medtronic, all the pumps and CGMs are separate. I didn’t feel that any of those pumps + Dexcom together were better than Omnipod and Dexcom separate. I don’t really think having them separate is really that big of a deal.

The way I see it, you can have a pod, a PDM and a Dexcom or a pump set, an integrated pump and a meter. But it’s still three pieces to the puzzle.

How is the failure rate compared to the tubed pumps?

This is a great question, and I wish I had hard data to back up my answer. I have had four pod failures in as many months, whereas I only had four pump failures in twelve years. That being said, a pod failure is not the same as a pump failure. Pump failures put you out of commission for a day, maybe two. With a pod, you can easily fix it by putting on a new pod. Sometimes you can even salvage the insulin.

I’m not sure how occlusions and bad sets compare to pod failures, because bad sets are so much harder to track. I imagine that bad sets happen pretty often though, but as many people note, you rarely lose insulin when you have a bad set. I do wish there was some kind of retrieval system for insulin in a pod. Using the syringe to suck the insulin out of the pod sometimes works, but more often than not, a lot of insulin is stuck inside.

 

Have a question I didn’t answer? Leave it in the comments!

It’s All About Timing

exerciseI feel like this is the secret to diabetes that no one mentions and no one can really figure out: timing.

How long does insulin take to start working? How long will it take for my food to digest? How long will it take before my physical activity ramps up my sensitivity?

It’s all about taking the various pieces of our diabetes management and laying them out properly so that everything lands at just the right time. I remember my childhood endocrinologist drawing graphs of when NPH and regular peaked and the idea was that we would have everything timed to my meals. Of course, the timing of my meals and the peaks of insulin were never the same, and that’s the point. We rarely live in a space where timing can be exact, and that’s what makes diabetes so incredibly mind-numbingly impossible to understand and manage.

Lessons in timing have been readily apparent in the last couple of weeks as I get a better grip on my exercise regime. For a long time, I only exercised at night, which worked well because I’m not a morning person, except I found that I went low with any on-board insulin from dinner. No matter how little I took, I always seemed to drop halfway through my run. So I switched it to the morning, and now I don’t go low, but sometimes I will go high from the insulin resistance. I also need to eat something before I exercise. I’m not an empty stomach exerciser or I feel very fatigued. I need to have some fuel in my system, and that fuel is usually carbs. But carbs = insulin which = lows. Fun stuff, huh?

I’ve been playing around with various tactics and I think I’ve found a couple that work. It was actually something Gary Scheiner said at the Insulindependence conference that I attended last month. He said that occasionally he will eat dinner and then exercise and then bolus for his meal, because the exercise delays the digestion of a meal because all the blood is being diverted from the stomach to the muscles. I thought for sure I would skyrocket if I tried something like that. But this week I decided I wanted to take a couple evening classes at the gym — a cardio kickboxing class and a Zumba class — and both of them would be after dinner. So I had dinner and then almost immediately after dinner (within half an hour) went to the gym and worked out. I held steady in the 90s the first night, and then the second night I actually went all the way up to 250 before coming back down by the end of the class.

After the first class, I bolused the full amount and the second night I bolused half the amount, but neither one seems to be the sweet spot. The full amount is too much, and half is too little. Three-quarters? That’ll be fun math to do in my head! But I loved that I was able to take a class regardless of the time of day and enjoy it and not go low. I also still had the benefit of taking less insulin, which is a key in losing weight.

In the morning, I typically wake up and have a GU gel. They are 25 grams of carbs and 100 calories, but so far I haven’t been bolusing for it and paying the price later with a high blood sugar. I plan to experiment by taking a partial bolus of the GU after a run, and then in addition take a partial bolus of my actual breakfast. I’ll have to tweak the percentages a bit, because it’s not likely that every day will be exactly the same! But it’s nice to have a base to work from and a strategy that — for now! — seems to be working pretty well.

I know a lot of people struggle with exercise, so I wanted to share in case anyone else thinks this might be useful (although it’s obviously not medical advice!). Do you have any exercise / blood sugar strategies to share?