LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Monday, December 05, 2005

Work flow, the rituals of daily life

Time to eat! But, of course we aren't ordinary people are we? While everyone else feeds their faces we are trying to figure out how many $#%&@! carbs there are in that plate of quickly cooling food. Oh well, what can you do?

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.


Blogger KarenB said...

Great post! I enjoy your writing.

9:58 PM  
Blogger skytor said...

Thanks for your posts Wil! I really enjoyed eading them and will certainly be back to your blog soon. I am very interested in aquirinig a Guardian RT also, and it's great to be able to hear experiences of the pioneer users like yourself.

And about juggling devices and entering the same numbers and calculating information in different places, I know how you feel: I juggle the pump (minimed 512), my BG meter (Lifescan Ultrasmart), my log software (onetouch software), my carb counting book, and on top of that a paper logbook. I find it quite frustrating that these big medical companies are not capable of improving our lives more, making products that communicate with each other, software that makes sense, etc etc.. Finally, I find the slowness of the FDA approval process horrific. I think we'd be much better off if companies could get easier access to the medical market and to innovate new products. OK, I just had to vent..

Anyway- keep up the good work Wil!

- skytor

4:43 AM  
Blogger Melissa said...

Every day I check in to see how the drama that is your life will unfold. I love the way you tell a story! Thanks for reading my blog as well. Somehow it makes me take the DB more seriously because more poeple know I have it.

I have had many a cold dinner because of this damn process. When I go visit my family in San Diego my mom always lets me figure it all out before everyone sits down to eat, which makes it a lot less akward. If only waitresses could be so kind.

6:01 AM  
Blogger Ellen said...

I admire your dedication and attention to detail with all the gadgetry you are wearing, as well as your tenacity to integrate all of the data.

Do you ever question if in some way wearing the Guardian and the sensor and the pump and analyzing your carb info etc. takes away from your quality of life by having to think so much about every detail surrounding the bionics? How long do you think you can happily keep up with all of this 24/7? Perhaps because it was your choice and not imposed, it doesn't feel like a burden.

Life with all the new gadgetry seems burdensome/overwhelming to me as a mother of a young adult with diabetes. I don't envision encouraging my son to manage so much as I send him off to college next summer, even though I'd love for him to have access to the continuous data and especially the warnings of the impending lows. It's so hard to find balance.

Thank you for the vivid details which are second to none. This is an award deserving blog.

6:39 AM  
Blogger Wil said...

Karenb--thank you!

Skytor--Thanks! ...and Vent all you want.

Melissa! Hi! M is the author of "How's the DB?" If you haven't visited her blog yet, you need to.

True, too many cold dinners! Maybe that's why I'm in the habbit of eating at the same places when I go out...


To answer your question, I think all of the 'work' increases the quaity of my life. I enjoy the challenge and I like playing with the equiment. I don't think I'm gonna burn out on the 24-7 nature, but I'm sure others might. Of course they don't have to use all the features, either.

Your son could use it simply as an early warning sytsem. It would be worth the cost for that alone. He can just put it on and forget about it. It'll do the job all by itself. He doesn't need to use all the bells and whitles. Of course, if he 'gets into it' later he has the options of using the more advanced features.

RE: award deserving. You are so sweet! Well, the DiabtetesOC are hosting the first ever diabetic blog awards. Maybe some one will nominate me....

6:05 PM  

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