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!).

Tuesday, March 31, 2009

Skin deep?

So on to the Navigator. Let us start by judging the book by its cover. The color is a sexy tritium grey. Sparkly. Navigator one. Guardian zero. Guardian is “smoke” colored, a grey-green and not very futuristic looking. Guardian is housed inside a Paradigm case. If you hold it up to the light the bottom is hollow where the driver rod and insulin cartridge would go in a pump. So there is a void of nearly three inches long and quarter-inch high that could have housed an AMPLIFIER to make the damn thing louder. I guess using an existing pump case made sense from a production point of view. Abbott, having no pumps, was free to make their CGM any size and shape they wanted to.

Both CGMs are plastic, and they both look and feel plastic. Neither has the quality feel of… oh, I don’t know… an Apple I-phone or a Presto blood glucose meter. You can make something from plastic without it seeming “plasticity,” if you know what I mean.

Without bothering to read any of the manuals and quick-start cards, I put two triple-A sized batteries in the Navigator and dicked around with the receiver. The purpose of the bizarre shape of the system’s brain becomes apparent as you handle it. It is a rectangle that is concave on the sides and convex on the top and bottom. This actually makes it quite gripable in the hand and is surprisingly ergonomic. It is slightly thicker than Guardian, but not by much. They are the same dimension left-to-right as well, but Navigator is about half an inch taller on the top-to-bottom dimension. Overall, however, Navigator seems much larger when you look at the two units side-by-side.

Navigator features four buttons to guardian’s five. Navigator’s menus, like OmniPod’s, navigate cell-phone-style with the two bottom buttons serving as a back and forth navigation control and the two vertical buttons on the right serving up-down navigation. It is very intuitive and quick to learn. Med-T menus, of course, are a bit more like learning Braille. That said, once you learn it, you can get around a Guardian quickly, it just takes a little longer to learn.

When you wake Navigator up (bear in mind I do not have a sensor hooked up, only time will tell if a glucose status screen remains on all the time or if you have to wake the device up to find out what your blood sugar is) you are at the Glucose CM Screen. Right now mine shows the time, - - -, and an lightning bolt with a slash that I assume means it has no telemetry with a sensor. Once it is hooked up the - - - is replaced with your current sensor glucose level.

From Navigator’s home screen (called Main) there are only five menus (and the damn thing times-out pretty quickly, making you start all over each time it times-out; the machine wakes up at the CM Screen, not where you left it. Growl). The menus are: Glucose, Alarms, Reports, System, and Add Event. Clicking on Glucose takes you back to the main screen. Alarms is where you set your preferences for how loud a beep or how long a vibe you want; and where you choose your various alarm thresholds and sensitivities. More on that tomorrow.

Reports takes us to graphs, stats, event history, glucose targets.

System appears to have controls for hooking up to a sensor and sub menus for changing time and the like.

The Add Event screen lets you add in insulin, food, exercise, and a variety of health conditions. Presumably these will then show up on your download. I was amazed at the variety of health conditions you could enter including--but not limited to--sore throat, stress, allergy, alcohol (no shit), and for the ladies, your Period.

I found the Navigator to be an easy device to navigate around. For comparison a quick reminder of the Med-T menus. The infamous green ACT button takes you to the main menu where there are only three choices: Sensor, Capture Event, and Utilities. Frankly, most of the operations happen in Sensor including all the setting of alarms and starting of sensors. Pressing the ESC key from just about anywhere can take you to graphs, then to two data sets that tell you anything you’d want to know, and more, about the status of the system.

To be fair, I always found the Guardian’s menu and button system less exasperating than the Med-T pumps. I think both Navigator and Guardian are fine in this regard and you’d quickly adapt to either. Navigator one. Guardian one. On this the systems tie.

Guardian has two belt clips to choose from, same as the Med-T pumps. One is a low-profile design popular with many of my female kinfolk. It snaps on nearly flush with the pump. The other style, which I love, is the holster model. This is a plastic hard-shell belt clip with a rotating clip that the pump (or Guardian) slips into and out of with a satisfying CLUNK-CLICK. I find I have the Guardian in-and-out many, many, many times during the day. To me having to UNCLIP it from my belt would be a big hassle. I guess for a pump it wouldn’t matter so much. That said, I use the same style with my out-of-warranty-and-discontinued Cozmo pump.

Navigator’s belt clip is also a holster model, but seems cheesier, not as robust as the Med-T holster. It is also a LOT harder to get the damn thing out too. Now, in fairness, it is brand new….no wait, Med-T holsters are easy to use from day one. It think it is a fundamental design flaw. The Med-T holster is U-shaped, open at the bottom. You can reach down and “flick” the Guardian out of its case quickly and easily. The Navigator holster has a closed bottom with a finger window you can use to push it out. In theory anyway. Also, the Med-T holster rotates for horizontal or vertical wear. Navigator can only be worn horz.

The clip itself is quite large too, holding the receiver out from the body quite a bit. Overall, between the size of the device and the design of the holster, it is not at all comfortable. And I’m a full sized man. It would be miserable for a child.

It also has, as an option, a silicone skin, a’la I-Phone. I’m trying to figure out under just what circumstances I’d use this. I suppose it would be good protection if you carried the receiver in your purse. But then would you hear it? And what’s the point of having CGM if you don’t get in the habit of glancing at it every fifteen minutes or so to keep in touch with your diabetes?

Also in the box the Navigator came in was a rectangular transmitter about the size of a club cracker. It takes a 357 button battery that the manual says will last a month. I googled the battery and it looks like you can score them for ten bucks a pop at battery places, but has them for three bucks; and it looks like if you buy a shit-load of them you can get even better prices. But one more damn thing to buy and carry. I prefer the Med-T rechargeable approach, and it’s curvy seashell transmitter is smaller too. The transmitter is the part of a CGM system that takes up skin landscape, so the smaller the better.

Going back into the distant past of CGM, (which was what, four years ago?) the transmitters were large sealed affairs the size of those things you unlock a mini-van with, and had a cable that attached to the sensor. It would run about a year and cost a fortune to replace. The new Med-T transmitter has a recharging dock powered by a cheepie triple AAA. I plug my transmitter into the charging dock for about 15 minutes while I’m in the shower every sixth day and have never had a problem. Oh, let me be clear about this: I shower every day, but only change my sensor every six. I suppose someone will argue that eventually rechargeable devices cease to hold their charge and at $800 bucks or so to replace, I may wish for a system that cost me a couple of bucks per month in batteries.

The Med-T transmitter is dover-white. The Abbott is battleship-grey. Now God makes us diabetics in a wonder array of colors, but dover-white and battleship-grey are not amongst them. The powers that be at these companies are afraid to choose a skin color that would match most of us (my vote: Indian. Middle of the color continuum. Darker than me, lighter than an African American but better on everyone than dover-white or battleship-grey).

Actually, you may have witnessed the evolution of those stupid things people are wearing in their ears so they can be on their phones 24-7-365. They are becoming jewelry. What a perfect solution to technology that serves a life support function. Simply make it beautiful. Chrome, or gold, or even clear to show the funky circuit boards underneath.

I’d love it if they’d at least stamp them with a medical alert symbol.

The Navigator transmitter also features a plastic arm, or spike, that helps it mate with the sensor. I’m guessing this might break easily and ruin someone’s day.

Med-T sensors come in a sack and can be inserted either by hand or with a re-usable inserter. Navigator sensors come with an appalling amount of land-fill bait. More on that when I put the first one in.

Oh well, nothing about diabetes is land-fill friendly.

Next time: alarms. Options and lack thereof.


Blogger Mary C. said...

You are so right about the amount of non renuable detritus one diabetic generates. When I think about all of the insulin pen caps, syringes, insulin vials, alcohol swabs in foil lined packets, lancets, test strips, plastic strip containers, plastic inserters, infusion sets, tubing, spent sensors, batteries, plastic adhesive bandages to keep everything from falling off, Lord knows what kind of toxic chemicals necessary to get the tar-like goo from the bandages off, and the list only goes on. Mother Earth, please forgive us.

6:47 PM  
Blogger Scott K. Johnson said...

Glad you clarified the shower thing... :-)

9:54 PM  

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