Work flow, the rituals of daily life
To use the Guardian to her fullest advantage you are going to have to add a few more steps...
Now before you all start wailing and crying, I want to point out that some of these are optional. There is no law that says you have to use all the features of your gadgets. My Mom's VCR blinked "12:00" for at least 15 years....
First and foremost, you need to do a finger stick twice per day (every 12 hours) and enter that data into the Guardian for calibration. That is not optional. Medtronic also recommends that you take a finger stick to confirm any time you are going to make a therapy adjustment. With me the jury is out on the necessity of that, but they need to cover their legal hinnies. I digress...I do take pre-meal finger sticks still, and I enter all three of those into the Guardian to keep her calibrated. Re-cap: you must enter at least two BG readings per day, and she'll remind you if you forget; but it is OK to enter more than two.
Back to eating. Picture me at the table. If I'm home or eating at one of my regular haunts I've got a little note book full of carb data--a quick glace tells me that if I'm eating the ham, swiss, and green chili sandwich with the home-made garlic-herb potato chips at the Zia Diner in Santa Fe, it's gonna cost me 85 carbs. If I'm feeling naughty and add the hot fudge sundae I'm going to need an extra 125 carbs . All of this from the guy who normally never eats more than 30 carbs in a meal! Well, when you're eating out you gotta live a little....
If I'm some where strange, or if I'm feeling adventurous and trying menu items I've not had before, out comes the PDA and the two pocket carb counting books. Some scribbling, muttering, and third grade math later....don’t forget to add some carbs for the ketchup on your fries, full of sugar you know...and I have a carb count for the meal. I keep a food log, so I always try to write down everything I eat and what I thought the carbs were. If I spike at 350 I estimated the carbs low. If I crash into Hypo Town, I estimated the carbs high. Either way I’ll be smarter next time. Diabetes is a lot of work.
Next, I pull out the vial of Freestyle test strips and the little two-inch lancing device from their pouch on my belt. Next I unclip the pump and unsnap the case cover. Then I pull the Guardian Monitor off my belt and flip open the cover with a flick of the thumb. Time for battle.
In the “old days,” (about two weeks ago) my work flow was something like this: first a finger stick. Test strip into the meter on the back of the pump. Double check the code number, 17 on this batch. Cock the lancer, choose and finger and SNAP. Give a little squeeze for the blood, touch the edge of the test strip to the blood dot...ZIPPPPP... it sucks it in. A few seconds later I have the reading. Next I select “meal bolus” from the pump menu. I have different carb to insulin ratios for each of the major meal times, so in this case I choose “lunch.” The pump prompts me for the number of carbs. I enter it and go to the next screen which asks me if I want to add a correction bolus. I almost always do, unless I’m adding a desert on to the end of a meal. The pump already knows the BG, ‘cause the integrated meter that I just used told it the current reading. The next screen tells me how much insulin it will pump. One more button to press and the insulin starts pumping, in my case over a one minute period.
But...the Guardian also has places to store a lot of this info, and although it is more work to enter it in two places, the data is then in the Guardian software, which makes things easier at the end of the week when I’m doing a post-mortem on my BG readings. Now the juggling starts!
Finger stick. BG 99. Go to Guardian. Press SEL twice. The screen reads “meter BG.” This is the same screen you use to enter a calibration value. In fact, any BG entry is used by the Guardian to help it compare what it is seeing with another known value. Go back to pump.
Once I’m to the point where the pump is telling me how much insulin I’m going to pump I pause and go back to the Guardian. SEL three times to Events. The Events are: Insulin, Carbs, Exercise, and Other. So here you can enter the insulin pumped and the carbs in the meal. The Guardian remembers the last value you entered, so if your meals tend to run about the same you won’t have much scrolling to do. The numbers are changed by using the up and down arrow buttons. The longer you hold the button, the faster it scrolls.
Once you’ve entered and confirmed the insulin you do the same for the carbs. I use the Other category as a flag if I’ve used a Combo Bolus. All of the Events do not effect the operation of the Guardian. It is just a way to store more information in the electronic log book.
Now back to the Pump. Let her rip. Put test strips and lancer back in their pouch. Clip pump back into place. Guardian back to belt. PDA, note book, carb books back into my “go bag,” where they live crammed in with cell phone, Glucagon Emergency Kit, spare batteries, extra infusion set, and all the other accessories of the modern diabetic on the go.
What? What did you say? It’s time for dinner already? But I haven’t even started my lunch yet!
Well it seems that way sometimes, but it really isn’t that bad. Takes less time to do it than to read about it.