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, April 13, 2009

Shot through the heart with the TRU arrow

“Shot through the heart,
And you’re to blame,
Honey, you give love a bad name.”


--Bon Jovi

So I can safely say that so far, what I hate most about Navigator is the long spool-up time. The thing I hate the second most is the lack of user-adjustable snooze alarms. If you are high or low she’ll pester you every fifteen minutes, until her batteries run out our your BGL recovers. But for a change of pace let me talk about what I DO like about the system.

In no particular order, as I have not infused enough caffeine yet today: how do I love thee, let me count the ways….

With apologies to Huge Heffner (who even at, what, 102 years old? is more of a “man” than I): three girls in bed with me is just too many. I’ve got Guardian, and Cozmo, and now Navigator. Oh, and on rare occasions, my wife. That’s four girls in bed with me. I’m too old to enjoy that. So one thing I discovered and loved is that Navigator will work on my nightstand. She seems to have a more robust signal strength than Guardian.

Officially she has a ten-foot range, but my experience, in medical devices that use wireless the rage is always much less than the published figure. I suspect radio range is tested in large empty warehouses by naked people. Probably Heff tests them for the FDA. Guardian will not work for me on the nightstand, she loses telemetry. In fairness, part of that may be my choice of sensor location. I wear Guardian sensors on my legs. I have for years and years, since the original Garage Door Guardian.

I get much better sensor performance and accuracy with Guardian on my leg than on my stomach. I tried to place one on my arm a month ago and it went….badly. I still have a bruise. It went in with no trouble but preformed badly and starting hurting. I pulled it out the next morning to a hell of a gush of blood. Our white porcelain sink looked like a murder scene. Oh, that’s your tip for the day, if you’re gonna murder someone make sure that there is no white porcelain around. Damn hard to get blood off of. I was late to work. When my boss asked why I was running late I said Oh I was having a hard time cleaning up a murder scene. She just gave me the “why do I waste my time asking you anything” look and went back into her office.

But once again, I’m off track. Because I wear the Guardian sensor/transmitter package on my leg, it is both further from the night stand and buried under more blankets and so-forth than the Navigator sensor, which I have on the back of my upper arm. Might or might not have a thing to do with it. I suspect that Navigator has a more powerful transmitter than Guardian, but I wanted to present all the evidence to be fair.

OK, now this is embarrassing, as I spent quite a bit of time trashing the TRU arrow…but…I like it. Yep, I confess, this is one of those things, like calamari, that you really have to try to appreciate. In fact, the entire Navigator “dash board” is much more user friendly than I had given it credit for. The read out is large and the screen contrast is excellent, especially with the back light on. Tied in with this, I don’t recall if I talked about the belt-clip/holster discovery yet. On first looking at it I bitched about how thick the clip was. It turns out this is an articulated clip, allowing you to quickly angle Navigator perpendicular to your body. Think boy scout with compass on belt.

The bottom line is air-plane style information.

When you are flying a plane it is a really good idea to spend most of your time looking out the windshield so you don’t hit stuff like other airplanes, cell phone towers, or mountains. So the instrument panel is designed to deliver information to us in an instinctive and graphical way, just like a quick glance at a traditional watch can tell you the time with no brain power. Now no one has developed a fuel-gauge-style blood-sugar-level graphic (but it is a good idea). But maybe we don’t need it. From the day we are given our first glucometer (hopefully the day you were dx’d) we have to think about NUMBERS.

Not only do we learn numbers, we learn to obsess over them. “Good” numbers make us happy. “Bad” numbers make us angry, sad, or in need of a stiff drink. Or cake. Neither of which will make the bad numbers better. Of course a number is only a number. You can’t take it personally. Easier said than done, I know. Numbers are no more than information. I say rejoice in bad numbers because it is good information.

CGM gives us numbers in a new dimension. Before CGM numbers were two-dimensional. Flat. Isolated. Poured in concrete. A fuzzy, grainy snap shot of one single second in a day that has 86,400 seconds. CGM allows these numbers to jump into the world they really exist in. Paintings become sculpture. Photos become movies. The flat two-dimensional number becomes a living, breathing, three-dimensional object. The value of the information sky rockets to the tenth power and beyond.

Is a BGL of 104 good? Sure, if you just woke up. No so much so if you took 14 units of fast-acting insulin an hour and a half ago. Is a BGL of 278 bad? Maybe. Maybe not. If you were are 392 a while back and you are dropping nicely it should be considered “good” as you are improving on target.

So the TRUTH about the TRU arrow is that it works. Well, damn. I hate being wrong. But there you have it. Navigator’s compass rose arrow is damn handy. Picture me driving home from the clinic. Some evil bastard has left home-made brownies on the carb table at work. I resist them until 3pm when my energy wanes along with my will power. I scarf and bolus, but it is too much sugar for my poor little pathetic diabetic body. Fast acting insulin really isn’t fast enough. Before leaving for home I’ve hammered away at the high with two correction boli. And being a control freak…err….enthusiast… I even add a little to each bolus. I’ve probably stacked my insulin. This could have a bad outcome.

So I’ve got the radio cranked up. The cruise control set at 80 mph. Did I say 80? I misspoke, I meant to say I had the cruise control set at the speed limit of 75 mph. I’m smoking a Falcon pipe and enjoying the fact that the sun is still up. Not long ago I was driving home in the dark after sunset.

To check my “sensor glucose” I have two recipes.

Guardian. Without taking eyes off road, each down, quick flick of finger frees her from the holster (yes, I’ve dropped her on the floor of my car a few times). Next press SHIFT and the DOWN arrow at the same time to turn on the back light. Guardian backlight is that eerie green that reminds me of the night lights my Aunt Dora had in nearly every plug in her house. Guardian (and Navigator too) have Liquid Crystal Display screens. These tend to be low contrast and in some lighting conditions impossible to see. Shit…err…Shift and Down at once is a two-handed operation. No problem. The car practically drives its self and I can clench the pipe in my teeth. I keep Guardian on the six-hour screen, so I get a number and to the left a trace that allows me to put that number into perspective. I also have some arrows to warn me if the changes in the last few readings are happening pretty fast. I generally hold Guardian on top of my steering wheel so that I can more-or-less keep the Pt Cruiser in one lane or the other while looking at the sensor glucose numbers and studying the graph while also more-or-less looking out the windshield to make sure I don’t hit other cars, cell phone towers, or mountains.

Navigator. Without taking eyes off road, reach down and flip unit upwards with cleaver articulated belt clip. Next, by feel, press the Down button followed by the Right button. Glance down. Navigator’s report of your sensor glucose number is BIG. The screen backlight is a blue-grey that is really high contrast. I also think that Navigator’s screen is higher resolution as things don’t look quite so “bit-mappy” as they do on Guardian. So you have this BIG ASSED number and then you have this BIG ASSED TRU ARROW that tells you the direction and speed of the flow of your glucose. Slow lazy and flat; moving up or down faster than is strictly healthy; or the shit is hitting the fan fast.

Oh. I’m at 110 and dropping like a fucking stone. The TRU arrow is pointing straight down. As she’s on my belt the arrow is pointing at my stomach, threatening, all set to eviscerate me. I’d better do a fingerstick….

Two cherry slices got me home alive.

Next time: ups and downs

2 Comments:

Blogger CALpumper said...

Is it wrong that I laughed through that entire post?

Yet another great one!!!
Thanks for sharing.

And I wonder if the laws (at least over here in upstate NY) will have a stipulation for pumps and CGMs.....this summer it will be against the law to drive and text at the same time. Good law.

But (as I was doing a correction bolus yesterday driving home from church after a bad night of a nasty low, subsequent fun "somogyi effect" highs still plaguing me Hours later) I thought, "I am looking down, back up, down again, driving with one hand, using the other to press buttons...."
I am Not texting. I have a cell phone but No service.
So if I get pulled over will the Officer "believe me" in that I needed to do a bolus? Like he would have Any idea what the hell That word means. Would he warn me, tell me to pull over to take care of it next time?
I have never been pulled over (knocking on wood) in over 15 years. Not once. For anything.
Same fear that we T1s have if we get low, try to eat something While driving? Hmmmm. Things to ponder.

9:04 AM  
Blogger Scott K. Johnson said...

I've been really impressed with the range on the FSN. But battery strength in the transmitter does make a difference.

I am often able to play basketball, with the receiver on the sideline of the court, and be gathering data and watching out for highs/lows the whole time.

That was one really bothersome thing I experienced when trying the Paradigm system. The two would lose connection often, even when I had the pump/receiver on my beltline and the sensor on my stomach (opposite side). Granted, there's a whole lotta stomach there, but c'mon!

9:57 AM  

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