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!).

Saturday, March 31, 2012

Med-T’s BGL meter: UltraLink or UltraCrap?

(Alternate title: Everything you ever wanted to know about the UltraLink but were afraid to ask.)

Brew some coffee boys and girls, this is a long post.

I think that as a society we’ve finally admitted that size really does matter. And that’s the first of a great many complaints I have about the Medtronic-branded OneTouch UltraLink blood glucose meter: it’s too damn big.

It is, in point of fact, larger than the frickin’ pump. That’s just wrong. It’s every bit as heavy, too, at 3 ounces with batteries. And it’s thick. And clunky. And to add insult to injury, with all this size and bulk it doesn’t even sport a backlight.

All it does is check your fucking blood sugar.

Oh yes, and it sends that info to the pump. But that’s nothing new. Med-T meters have been talking to their pumps for years. Before BD pulled out of the test strip biz, they made a meter that talked to earlier generations of Med-T pumps. Of course, BD strips were absolutely miserable, especially on the low end, so Med-T is well rid of them.

But, with no more contract with BD, a clean slate—and with Abbott, AgaMatrix, Bayer, Roche, and a dozen more to choose from—this is all the better they could do? Do you really think a meter needs to be almost an inch thick to hold a radio transmitter? I doubt it.

So is there anything I like about the UltraLink? Let me think for a minute. Ummm… No. Nothing. Nothing at all.

It should be small, light, and sexy. It should match the color of your pump. (UltraLink only comes in one color: silver and navy blue.) It should have a screen backlight at a minimum, and preferably a strip port light à la FreeSyle Flash and 2nd Gen OmniPod. It should have an audio tone to let you know when it has enough blood on the strip, especially as the screen is darker than Hades at midnight during an eclipse, and we type 1s frequently need to test our blood sugar during the night and wee hours of the morning. And it should be a real self-coding meter.

Let me expand on that last point. If you wanted to own an industry (as in have all the money they make deposited directly into your Swiss bank accounts on the hour every hour), two desirable industries jump to mind. The first is the inkjet printer ink industry: the makers of the most expensive liquid on the planet with the exception of some cancer/chemo drugs. Yeppers, inkjet ink is more expensive per ounce than aged Scotch, French Perfume, whole blood, or Fiji Water—the last one arguably over-priced but very yummy and one of my personal favorites. The second industry that jumps to mind as desirable to own is the test strip biz, as strips can retail as high as a buck a pop, have a built in customer base who will literally die without the product, and is heavily subsidized by Medicare and most private insurance.

Of course, insurance companies are greedy bastards who don’t want to pay for anything, are quick to cut back-room “exclusive” deals for discounted prices, limit the number of strips a member can have and other nasty tricks. So what’s a poor strip maker to do to maintain their grotesque profit margins?

The historic approach has been to make the strips in a sloppy way, milking a few extra pennies of profit out of each strip. This makes an already inaccurate product even more inaccurate. The workaround is to “code” the strips. A code is simply a measure of how bad the quality control of a batch of strips is.

Coding can be done either with a “coding chip” that comes with each box of strips that plugs into the back or side of the meter (Roche style); or by entering a code number printed on the strip vial into the meter using the meter’s “Up” and “Down” arrow buttons (FreeStyle and OneTouch Style). The code communicates to the meter how much to alter the test results by to offset the sloppy production. Simply put, a code might tell the meter, oh this batch is reading 30% low; or that batch is reading 15% high.

I. Hate. Coded. Meters.

They’re the bane of my professional existence. Why? Because when a coded meter isn’t coded right, the results can be breath-takingly off. And I guarantee, any patient with a coded meter will, sooner or later (usually sooner), neglect to code it right. And that results in lots of lost time and effort, significant frustration, and a high risk of therapy errors that can hurt people.

Maybe even kill them.

Now the folks at OneTouch (a division of little company called Johnson & Johnson) are no fools. There were fighting the Abbott folks (FreeStyle) who jumped on the code-free band wagon early; as well as newer and smaller upstarts like AgaMatrix/Wavesense who were taking a bite out of J’n’J’s market share. But, of course, creating a self-coding meter also requires a fresh FDA approval. We all know what that means. Time. Lots and lots and lots of time. And wheelbarrows full of money, too.

So OneTouch did a fascinating workaround to turn their coded meters into no-code meters. They now only make Code 25 strips. Remember the movie Demolition Man where all restaurants were Taco Bell? Yep. J’n’J now only makes Taco Bell strips. So you code your meter once and forget about it. No more coding errors.

So why am I still sore about it? Well, because my time is valuable. Even seven seconds of it. And that’s exactly how long the stupid UltraLink presents me with a “Check Code” message before I can test my blood sugar. My old Presto meter was ready for blood in about a second-and-a-half after I put the strip in it.

I know, it doesn’t sound like that big a difference, but I can’t tell you how many OneTouch test strips I’ve ruined in the last couple of weeks by touching the strip to the blood before it was ready (and mind you, I stick the strip in the meter, then lance my finger).

Oh, but speaking of lancing, the cute little stubby lancing device that comes with the Med-T branded UltraLink is top-notch. I love this little one-handed wonder and have actually been using them with whatever other meter I’ve been using since they first came out. Best lancing device ever. It wins my Pulitzer Prize, Nobel Prize, and whatever honor I can find to heap on it.

But back to the miserable meter: I do actually appreciate the fact that UltraLink takes a pair of AAA batteries, rather than those crazy button batteries. AAAs can be found worldwide, even in the depths of the Amazon Rain Forest, should you find yourself there and your meter batteries kick the bucket. Now I recognize that my desire for both a small meter and one that takes AAAs may seem at odds, but a meter powered by a single AAA could still be very, very, very much smaller than the pump.

Another bummer is the UltraLink’s operating range, temperature wise. The manual states the meter will work from 43 to 111 degrees Fahrenheit. It does get above 111 at my house occasionally, but not very often. But this rules out leaving a meter in your car during the summer months for anyone leaving in the south or southwest. And on the low end, plenty of us d-Folk find ourselves needing to check our blood sugar below 43 degrees in the winter months.

The meter will read down to 20 mg/dL and up to 600. If you’re outside that range you’re in a world of fucking hurt anyway. Outside this range on the top you’ll get the friendly “Hi” greeting from the meter, and on the bottom it will announce “low.” Note that the sensor screens on the pump and Sentry will only tell you that you’re above 400. I guess once you’re in that DKA-friendly territory, it really doesn’t matter is you’re 500 or 600: You have an emergency on your hands.

The meter does have a bevy of other features that you’ll never use. So much so, in fact, that it comes with its own 82-page manual. The meter can be downloaded to a computer, but why would you want to? The data is all sent to the pump. You can download the pump data (delivery, alarms, overrides, etc.); the CGM data; and the meter data all at once, and have it all together in a single CareLink Report. UltraLink also lets you flag readings as being before or after meals, or add comments. Again, these features might be nice for someone using an insulin pen, but I don’t think they’re of much use to a CGM-enabled pump user. I would rather have had a backlight or a beep, thank you very much.

Speaking of features, the one useful feature that most meters have is the ability to scroll back across the last few readings. This is very handy during such adventures as severe blood sugar drops. It’s nice to be able to double check those last few readings before deciding how many more Butterfingers to stuff into your face. But this is no easy task with the UltraLink. First you have to turn it on with the “OK” button (pressing the “Up” or “Down” arrow buttons has no effect when the meter is off). Then you have to scroll down to “All results” and select it. God help you, if at this point, you make the mistake of pressing the “OK” button again, as now you are trapped in the comment menu. All three pages of it, including too much food, hard exercise, stress, menses, and vacation.

Give me a break, I just wanted to see my last several readings.

Now, I also want to take a moment to trash-talk the case the meter comes in. At least it has a belt loop. Many meter cases don’t any more. But that’s about the only good thing I can say about it. The belt loop itself is poorly designed with a half-inch of Velcro to hold it closed. I only used the factory belt case for about three hours and the meter fell off twice. The case is rather large at about four inches wide and six-and-a-half tall. It feels more like a courier bag on your waist than a cell phone case. It’s large, flaps as you walk, gets in the way of your arm, and is just basically annoying. And it’s ugly. It sports an outside pocket for a log book, as if any of us are actually going to write any readings down—they’re stored by both the meter and the pump.

Inside, the case features a very clever soft plastic molded meter holder that firmly grabs the meter (no more nasty clear plastic sheet over the meter’s screen!). There’s also a second contoured soft plastic holder for a vial of test strips, and an elastic loop for the lance. The UltraLink is a top-feeder, and the case is set up with the strips at the bottom. The whole rig could be used in situ without having to take anything out.

On the inside of the cover is the ubiquitous mystery zipper compartment all meter cases come with. What it’s for is anyone’s guess. Some people carry spare lancing needles in them. Why bother? You change your lance but once per year with your smoke detector batteries, right?

Oddly, there’re also two thick pads sewn on the top of the zippered pouch. They seem to serve no function, but perhaps they protect the meter’s screen from being scratched by whatever you might choose to put in the zippered compartment.

Back on day one, the 16th of this month, one of the first things I did after leaving the clinic was to drive over to Santa Fe and go to BestBuy. There I bought a Swiss Gear “Small Camera Case” measuring three inches wide by four and a half inches tall. The meter, lance, and strips all fit in quite nicely. It’s much smaller on the waist, and has a much more robust belt loop that’s sewn, not Velcro’d. The meter and the lance stand inside side-by-side and the vial of strips sits on top of them. I find it no problem to unzip the case and remove the gear when I need to test. If I acutally owned the meter, I’d probably Velcro the lancing device to the meter to make it even that much easier.

 So the bottom line is that there’s nothing “Ultra” about the UltraLink. It’s an astounding blend of a device that is supremely over-engineered on one hand, and missing even the most basic features a BGL meter should have on the other hand.

Oh, and it only gets worse.

Next time: looking at UltraLink’s strips

Friday, March 30, 2012

Why I’m not in California today

Ninety percent of the people I love most in the world are in Northridge, California, right at this moment. And I chose not to be there with them.

I am such a fucking idiot.

Today is the second Medtronic Diabetes Advocate Forum, where assorted high-profile members of the DOC are meeting with the biggest player in insulin pumps: Med-T.

It’s not that I wasn’t invited. I was. But I was worried about my pants.

I guess I’d better elaborate….

The very best way to keep out of trouble, I’m told, is to keep your pants on. But that’s not enough. Keeping your pants on is only half the formula. To really keep out of trouble, you must also look like you are keeping your pants on. Perception is everything. And therein lies my trouble right now.

You see, I was invited to the Forum. In fact, I went last year. I thought it was a great event. It helped us better understand them; and helped them better understand us. I’m pretty sure that’s the recipe for world peace, or at least something like it. I think great things will come out of these uneasy meetings between patient advocates and our counter-parts in industry. So, I if believe in it, why didn’t I go this year?

Because, not only are my pants firmly zipped up, it was also important that it looked that way, too.

You know what would happen: if I took a trip on Med-T’s dime, in the middle of reviewing their gear, at least 25% of the people out there would accuse me of having been “bought off.” And another 25% would accuse Med-T of trying to buy me off. The last 50% couldn’t help but wonder…

So I decided, after long and agonizing internal mental back-and-forth, to avoid even the appearance of impropriety by not going to the forum this year.

And to be honest, I also worried about my own famously infallible moral compass. If I’m a guest of Med-T will I be able to be completely honest in my review of Sentry? I think so. But I’m not sure. Actually, I think the risk is opposite of what you might think. I don’t think I’d give praise to a device that didn’t deserve it, just because the maker flew me to the coast to spend a day with a bunch of people I dearly love and rarely see. That’s not really in my make-up. But I do think if I found flaws in the system that I might be unduly harsh on Med-T. I might over-react to “prove” to everyone that I’m not in their pocket.

Sounds shallow, I know. But there it is. Best to be honest with yourself first and foremost. But actually, I swear, I’m liking the Sentry a great deal. I’m also liking his little sister, the Revel pump—although she almost killed me today. More on that next week.

Deciding to “pass” on the forum seemed like the right decision at the time. I’ve known for months when the forum would be. I’ve known for about six weeks that I’d be test-driving the Sentry. But when I realized how the two would overlap…by the time the Sentry system would arrive in my clinic office, the forum would only be two weeks away.

It was too close for comfort.

Too close for perception.

There was no way out. If I’d received Sentry when she was first approved, the timing might have been OK. But that didn’t happen. I debated starting my review late, after the forum. But that could have been perceived badly, too.

In the end, it seemed clear to me and my rusty and battered moral compass that “passing” on the forum was the only, dare I say it…? The only ethical thing to do.

Anyway. Like I said. It seemed like the right decision. The proper and ethical thing to do.

Until today.

Today, I’m missing my friends.

Thursday, March 29, 2012

The Joy of Tegaderm

You have two hours to live.

Under any normal circumstances, that might be unsettling news indeed, but I’m thrilled for the head’s up.

What? Oh, not my life, I’m talking about the sensor’s life. The sensor in my right thigh has two hours left to live. This morning when I opened my eyes, the sensor icon on myAssistant was red. Small white numbers and letters nestled into the corner of the icon gave me the countdown to its demise.

Or is it 74 hours, not two?

Here’s the problem: Med-T sensors are FDA approved for three-day wear. They do just fine for longer, and in practice, everyone I know wears them for longer periods of time. For me and Goldilocks, three days seems too short, nine days seems too long, but six days is just right. But of course, being approved for three-day wear, all the gear is set up to recognize this. The work-arounds are super-simple, but today I encountered a minor hitch.

I couldn’t fucking remember when I put the damn sensor in.

Was it three days ago? Or six?

They say short-term memory is the first thing to go. So I guess I must be on my way.

This is also partly the fault of the newest love of my life: Tegaderm Film. For background, since day one I’ve been using Smith & Nephew IV 3000 dressings to cover my sensor/transmitter sites. This super thin semi-permeable film (designed to hold IV sites secure in hospital settings) helps to keep the transmitter secure, and protects the whole assembly for getting accidently yanked off my carcass when changing clothes.

Oh, and I didn’t think of it the other day, but we have to give points to Dexcom on this front: their sensor/transmitter sites do not need to be covered. Dex sensors are built into a little plastic foundation that has sticky tape underneath the whole affair, and the transmitter snaps into it. Med-T sensors only have sticky tape around the small hub and the seashell transmitter “flaps” loose in the breeze. Metaphorically speaking. Totally off topic, but pictures I see out of Europe suggest that the next generation of CGM stuff from Med-T addresses this. The across-the-pond seashells seem to have some sort of ribbon of tape to help secure them. Anyway, I don’t find the over-dressing to be a problem and I kinda like the extra security that comes from knowing my life support system is well-attached to my body.

But back to Tegaderm, when my box of goodies came from Med-T there were some IV-3000s, but there was also a box of Tegaderm. What the hell, I’ll give it a test drive, I thought. Well that’s a lie. I actually thought something more along the lines of: Shit! Why can’t they just leave fucking well enough alone?! For a guy who loves change, I’m slow to embrace it.

Anyway. The IV 3000 is soft, with a waxy feel to it, with a diamond pattern stamped into its surface. I imagine if you plucked a fairy’s wings off, you’d find them similar.

Tegaderm is a horse of a different color. Made by a tiny mom-and-pop company called 3M, it’s designed to cover wounds and protect skin. It’s more robust than the IV 3000. It’s thicker, shiny, and window-pane clear. I worried it wouldn’t breath well, and would give me some skin trouble.

Well, so far, so good. No skin trouble and the Tegaderm holds up great. So great, in fact, that it added to my trouble this morning.

After a few days in the shower, IV 3000s start to get a little…ummm…nasty. Water gets under them, leaving them fogged and wrinkled. Lint sticks to them. The movement of my jeans as I walk tends to curl up the edges of the film. Sometimes I need to replace the IV 3000 mid-sensor run, or slap a new one of top of one that is half-falling off.

Not so the Tegaderm. After nearly a week on my body it looks like I just put it on.

Which is when I realized that I use the sorry state of my film dressing as an analog sensor change alert. If I get a “time for new sensor” warning from the system and the dressing looks good, I can reboot for another three days. If I get a “time for new sensor” warning from the system and the dressing looks pretty nasty, I need to change the sensor.

So my day started out with me sitting on the corner of my bed with a calendar muttering to myself and counting backwards, forwards, and backwards again. I finally decided that the sensor, which has been running like a champ these last several days, was due for retirement. I shut off the sensor from the pump, and then pealed the Tegaderm off, it came off smoothly and painlessly. Then I depressed the little leavers on the edges of the sensor hub to release the seashell, and pulled it free. I slid the seashell into the charger to top up its tank, then pulled the sensor tape free and de-inserted the sensor. The area where the sensor had pierced my skin for a week was pale red, about the size of a pimple. No sign of undue irritation or infection. All looks good.

I finished my morning routine (turn on coffee pot, take Victoza, take thyroid med, brush teeth, trim beard, shave legs and stomach) then jumped into the shower. I don’t generally use alcohol or IV prep on CGM sites, so I like the put them into shower-fresh skin when I can. I also find that shower-fresh skin is softer, making it easier to slide the guide needle in. As I wasn’t paying attention last night, I didn’t pre-insert this sensor.

Still slightly damp, I open the vacuum-packed sterile bag the sensor comes in, scribble today’s date on the label, and set it aside as my new analog sensor age alert. I slip the silicone needle guard off the sensor’s guide needle, then remove the forward protective film. Med-T sensors, like Band-Aids, have two pieces of slick film that protect the sticky pad until you need to sticky it to your skin. The forward one is clear plastic, the rear is a fan-fold white paper affair. Next, I pull the paper one half off. It’s designed to pull out once the front half of the sticky pad is anchored against your skin, but I’ve had them rip on me in the past and then it’s damn near impossible to reveal all the sticky pad to the skin, and the sensor hub is loose for a week. An ounce of prevention…

With my right hand, I pinch up some skin on my left thigh. Holding the sensor in my left hand, I angle it more shallowly than the 45 degrees or so recommend: I’m lean enough that going in that deeply would slam the needle right into my muscle. Been there. Done that. Not recommend unless you get a job at a secret CIA prison and need a new torture technique.

My skin is thick and the needle is on the large side. It takes some elbow grease to break the surface, but then the guide needle slides smoothly in, Excalibur from the rock in reverse. I push the sensor firmly in, assuring the sticky pad is flush to my skin, and in good contact. In some folks, especially those with a little more fat, the needle likes to create a tough in the skin, pushing it down before breaking the skin. That can cause the sticky pad to stick to the edges of the trough and that exposes the top of the sensor to the air, which will screw up readings and or cause the sensor to fail. If you’re “fluffy” pinch a narrow mound of flesh.

I gently release my pinch, sensor still held in my left hand. With my right, I reach over the pull off the fan-fold paper. Next, I rest the middle and index fingers of my right hand on the base of the sensor, and using the thumb and index finger of my left hand, pull out the guide needle. The stiff needle out of my leg, I can safely rub the sensor site—sealing the sticky tape to my skin and forcing interstitial fluid around the sensor.

The next step is to make coffee. Well, I didn’t pre-insert, so the sensor isn’t “wet” enough to fire up. I need to give it about five minutes.

Coffee in hand, I pull the seashell out of its charger, which just gave me a solid green light—fully charged. I slip the seashell over the sensor’s hub and snap it into place. From deep inside the pale white shell an eerie green light flashes. The sensor is ready. Wet enough to start the warm up process.

From the pump I turn on the sensor, “linking” the sensor to the pump. It’ll be about two and a half hours before it’s ready for its first three day run. I’ve alternated my sensor changes and my infusion set changes to avoid possible infusion set issues on the same days that I have no CGM coverage. Still… Even though it’s only a little over two hours that I’ll have no CGM data, I feel oddly naked without the real-time info and my fingertips.

Oh. Wait. I really am naked.

I was so wound up in figuring out the sensor this morning I forgot to get dressed.

Yes, short-term memory really is the first thing to go…

Wednesday, March 28, 2012

What my wife likes best about mySentry

Tuesday, March 27, 2012

My thoughts so far, both negative and positive…

Not that I’m complaining… oh. Wait. Yes. Yes, I am. OK, here’s what I don’t like about mySentry so far:

The super-smooth shiny black surface of the Sentry shows fingerprints and dust. Blah.

The low-tech touch screen is OK, but I’m not wild about it. I think I’d like real buttons better.

The monitor brightness, at its lowest, is still brighter than most TVs.

The various alarms all sound too much the same. And hey, Med-T, why such a limited range of alarm noises? The system has a bunch of cartoon Avatars to choose from that display on the upper left of the monitor to “personalize” it, why couldn’t you have given us a pre-packaged collection of alarm tones to choose from, too? Even the world’s crappiest cell phone (that would be the one I own) comes with 20 pre-canned ring tones to choose from.

Why only one Outpost per system? If the monitor could receive data from multiple Outposts, parents and people with diabetes could be one step closer to having CGM wireless hot spots in their homes.

On the other side of the coin, things I do like about mySentry so far:

It’s loud.

The screen is big. And sharp. And clear. The colors are bold and beautiful.

It’s loud.

The changing color icons and trace screens let me know in a glace both the status of my body and my gear.

It’s loud.

Is recovers quickly from separation anxiety. When the Sentry has lost signal from either the Outpost or the pump, it quickly displays the data again as soon as the pump is in range of either device.

It’s loud.

The “silence alarm” button on the top is easy to use and well placed. During my writing days, when myAssistant is on my desk, I can just tap the top of the monitor when I’m leaving my desk to avoid “searching for pump” alarms.

It’s loud.

I like the fact that the monitor can receive signals directly from the pump, no Outpost required (if the pump is close enough). I like this ‘cause it lets me move the Sentry monitor around the house more easily.

Oh, and did I remember to mention it’s loud?

But I also like mySentry’s unexpected utility. I got involved with mySentry simply as a workaround to the crappy alarm volume on the Med-T Revel pump and CGM system. We haven’t had a chance to talk about it much yet, and we’ll get into it in more detail later, but the whole Revel pump-meter-CGM package is pretty sweet. Oh, sure, I have plenty of nit-picky complaints about it. But overall, it’s robust, effective, and pretty damn user-friendly. I actually like it.

One thing I had worried about was daytime. Going into this, I was freaking out a little bit worrying about how safe I’d be in the day, as the Sentry is really only designed as a night guard dog. But, as it turns out, for my work life, nighttime Sentry easily converts to daytime myAssistant on days when I’m working from home. I think next week, myAssistant may visit the clinic with me, too. But, actually, set to “vibrate” the Revel pump does a pretty good job of keeping me in touch with my blood sugar when I’m awake and away from Sentry, be it working elsewhere, taking a walk on the land with the punk, or driving.

Sorry, I got off track. I was talking about unexpected utility. I love the more readily available real-time info Sentry feeds me during the day. Its ability to help me manage hypos better. The way it reminds me to eat. These are all things I simply didn’t expect to get as part of the package. Icing on the cake, I suppose, but in the long run, features that may prove to be the most valuable aspects of the system.

If I was a more engaged patient, couldn’t I do all those things without Sentry, or with a Dexcom? Maybe. Probably. But ease-of-use is underrated. There’s a big fucking difference between what can be done and what is easy to do. I know when it comes to my fellow type 1s that I’m preaching to the choir, but for the rest of you, let me try to spell this out: diabetes is hard work. Unbelievably, unrelenting, incredibly hard work. And diabetes isn’t our only job. We still have to earn a living. Take care of our spouses, children, families, and friends. Take care of our responsibilities to our communities and to our country and to our churches. We exist on the ragged edge of exhaustion daily, just trying to get though the day with to-do lists from diabetes that never ends, plus all the things that the rest of you have to contend with, as well.

Sometimes it’s enough to make a grown man or woman cry. So sometimes just having to press one fucking button takes more energy than we have to give. Sometimes, just because it can be done, doesn’t mean we have the energy left to do it.

No one who knows me would accuse me of being a lazy man. I’ve got lots of faults, but that’s not one of them. But I’m the first to admit that when it comes to diabetes, the easier that it is, the more likely it is I’ll do it; and the more inconvenient that it is, the less likely I am to do it.

That’s the truth.

And mySentry, acting as myAssistant, is already making my diabetes life just a little bit easier.

Monday, March 26, 2012

Comparing red delicious apples to golden delicious apples

I’ve been getting emails asking me how the CGMs of Med-T and Dex stack up against each other. It’s still a little early in the game, but here’s my early thoughts (in no particular order):

Device size winner: Medtronic
I like the size of the Revel. It’s small, and thin, without being too small and too thin. On the other hand, I’ve always hated both the size and the shape of the Dex. Why a flattened football? Beats the hell out of me, but I have a theory. I think they wanted a certain size of screen, which ended up making the device too large. To try and make the device smaller, they cut corners. Literally. They cut off all the corners. But, the funky device size leads to a problem in our next category:

Device carrying options winner: Medtronic
The Dex case is pathetic. Worse than pathetic. Lamentable. Miserable. Pitiful. Wretched. Deplorable. But because of the Dex’s funky size, it’s near impossible to find a third-party belt case for it. I did get a Verizon case for the discontinued chocolate line of phones that sort or works, but it only because the case edges are stretchy cloth, and you can stuff the otherwise-too-fat Dex monitor into it. Dex also makes a silicone “skin” for the monitor if you’re a pocket-type person. When I was wearing cargo pants that was OK, but with jeans it’s an issue. Med-T, on the other hand, has two very excellent options. First, they have a well-designed molded plastic holster with a rotating belt clip (that unfortunately tends to break in the field after about six months and costs $17.95 to replace). I started my trial with this option as I had always loved it with Guardian. However, with Revel, it’s not quite so slick, as you now have the tubing to contend with. The second option is a low-profile clip that holds the device close to your body, the top back of the clip has a wide clothes-pin like thumb rest that makes slipping the pump on an off my belt a snap. I’ve decided I like the clip better than the holster, but I applaud Med-T for including both options in the box with all pumps they sell. I don’t know how well this one holds up in the field, having not used it much before, but replacement cost is $12.96. Oh, right, and Med-T also makes some sport cases and fancy leather cases for you suit-and-tie types.

Dust seal winner: Medtronic
Med-T gear is almost water proof, the same cannot be said for the Dex. Dust gets inside the Dex very easily, probably through the recharging port and maybe though the buttons. It can make the screen hard to read in some light, and makes it look ugly all the time. I hadn’t thought about it until just now, but in related vein, a Med-T unit would survive a dunk into a toilet. A Dex? Not so much so.

Volume, daytime winner: Dex
Dex is the hands down winner when it comes to device volume for alarms, both auditory and vibration. The Dex is louder and longer when it comes to making noise and more… I dunno… more strong when it comes to vibration. The Dex vibe is sex-toy worthy, so intense you can both feel it and hear it. Both companies get two thumbs down for not giving us the option of vibing and beeping at the same time. (Dex does have an option to vibe first and follow up with a beep at the next alarm; and if you ignore a Med-T long enough it’ll try other options to try to get your attention).

Volume, nighttime winner: Med-T (provisional)
If you are relying on the pump by itself to wake up at night, may I suggest you also buy pre-paid funeral insurance? But if you’re using Sentry in addition to the pump, it’s indeed much, much, much louder than Dex.

Screen readably winner: Dex
Assuming we’re talking about the screen on the monitor itself, I gotta say the Dex is better. It is bigger, but the resolution is also better, too. Of course, the Sentry is getting me spoiled and at this point, I think either device screen now looks a little too small for me.

Alarm sophistication winner: Med-T
Dex is a kindergartner and Med-T is in grad-school. Dex has one low alarm, one high alarm, and two choices for rate-of-change alarms. Med-T lets you treat your high and low alarms almost like basal rates. You change the thresholds at different times of the day. You can also select a much wider range of numbers for rate-of-change alarms, and of course, the pièce de résistance is the predicted high and predicated low alarms that make CGM that much more accurate and safe to use.

Insertion device winner: Dex
Med-T’s Sen-setter is an embarrassment. It’s awkward, poorly designed, and doesn’t have the power to implant a sensor in a bowl of Jell-O. Dex, on the other hand, has a very, very good inserter device. It looks scary, and it’s not something you can use intuitively. In fact, you can’t always use it even after spending a looooooooong time with the instructions. However, if someone shows you how to use it, you’ll find it simple enough. It can also be used one handed, so you can wear CGM sensors on your arms; something you can’t do with a Med-T sensor unless you have three hands. Med-T sensors can be put in manually (something you can’t do with a Dex), but the guide needle is on the large side, it scares the shit out of most people, and can actually be painful for others.

Transmitter range winner: Dex
I’ve found that the Med-T transmitter is quite a bit weaker than the Dex. It’s more easily blocked by clothing, bedding, or the bod. I need to wear the Revel pump on the same side of my body as the CGM transmitter is on (i.e.: left leg, left hip; right leg, right hip). With the Dex I could always wear the CGM on my right side, regardless of where I had the sensor.

Monitor charging: tie
Med-T’s power comes from a single AAA, Dex needs a wall every three days. You can actually make pretty good arguments for going either direction, and you can adjust to either one. Frankly, I really prefer a battery. It’s easier to carry a spare, or get a spare, than have to worry about lugging a charger along when traveling. Both devices have reliable battery-strength indictors.

Transmitter charging winner: Med-T
The Dex transmitter, like the original Med-T transmitters back in the day, is a sealed unit that lasts for a year. Unlike the original Med-T transmitters, the Dex one craps out by feeding your monitor funky results rather than just dropping dead. A replacement is about $850, but Dex won’t guarantee it unless you buy a brand new monitor to go along with it. What this effectively means is that the Dex system only has a one year life. Depending on your insurance, this can add up to a whole lot more cash out of pocket. Med-T’s seashell, on the other hand, plugs into a AAA-powered charger. I’ve found 15 minutes every six days (while I’m in the shower between sensor changes) keeps it chugging along very smoothly. Also only warrantied for a year, field reports suggest 2-3 years is a realistic life time, so long as the charging is kept up with. If you take a break from CGM and let the damn thing discharge completely, it will die.

Time out winner: Med-T
Med-T give us the option of leaving your CGM on, at the trace screen of your choice, all the time. This way you can glace at your waist and see where your blood sugar is at. Dex doesn’t give us this option.

Back light winner: Dex
Dex’s back light comes on when you press any button. I can’t recall if I set it to do that, or if it always does. Either way, it’s a very handy option. The screen also lights up when it alarms, helpful for finding it in bed at night. The Med-T requires pressing either one, or two buttons at the same time, depending on what screen you left the monitor on, to light up; and it does not light up when it alarms nocturnally.

But which CGM is more accurate?
Damn, I knew you were going to ask me that. You know, I’m really not sure yet. My first Med-T sensor for this project was actually a slightly expired one I bummed from another user because I wanted to pre-insert it the day before the official start, and I didn’t have the supplies at the time. It didn’t exactly cover itself with glory, but it was expired, so I’m more to blame than it is.

I was trying the whole pre-insertion thing because from past experience I had noticed that Med-T sensors are a little funky on their first day, and then settle it. But the first non-expired Med-T sensor gave me some trouble, too. If you call a night of eleven false alarms followed by a night of seven false alarms “some trouble.” The damn sensor was running well below my fingerstick readings; the opposite of the type of trouble you usually get from CGM sensors. Usually, CGMs run a bit higher and risk missing lows. Throughout my sleep shattered pair of nights I tired calibrating, changing alarm thresholds, stretching the re-alarm times, all in a desperate attempt to get some sleep without risk of, you know, dying in my sleep. Finally, so exhausted and frustrated, I one by one, turned off all the alarm systems. Threshold. Predicted. Rate of change. Then the fucking thing lost signal and woke me up to tell me that, too.

I’ve had better nights.

But since that back-to-back pair of nights, the Med-T sensor performance has been quite good. Now, as to Dex, when I switched to them several years ago, they were spot-on almost all the time, and when there were off, a calibration stick would change and correct the readout in a second. But I’m on my third Dex monitor now, and both number two and number three don’t calibrate the way the first one did—something I’m less than happy with. In recent months I frequently found Dex to be more than 100 mg/dL off from my fingersticks, so often that I was getting a “boy who cried wolf” attitude towards the machine and more than once came very close to throwing it out the window. I was ready to look into hypo alert dogs. And I don’t even like dogs. The errors were in both directions. Sometimes a random fingerstick would reveal me to be in deadly danger than Dex was blissfully unaware of, and other times Dex was screaming that the sky was falling when it wasn’t.

What happened to Dex? I suspect they are victims of their own success. Making sensors is hard work. Trying to predict and keep up with demand is tricky businesses. It’s not like you can just increase the speed of the assembly line or add a weekend shift for a month or two when business booms.

So the answer is I don’t know which sensor is more accurate or more reliable. Hopefully over the next six or so weeks I’ll get a clearer view of how well or how poorly the Med-T sensors are doing their job right now.

Don’t worry, you’ll be the first to know how it turns out.

Next time: But do you LIKE mySentry?

Sunday, March 25, 2012

A day at the office.

This must be what it’s like to be a stock broker or a commodities trader. Real-time info under your nose with no effort, all the time. Graphs. Numbers. A flood of information to help you make good trades at the right moment.

Yep. Today Sentry is working with me in the library, where I do my writing. And why not? There’s no reason for him to stay on the nightstand all day long doing nothing. As long as he’s within six feet of the Revel pump, no Outpost is required. And while not quite as portable as, say, an iPad, the Sentry really isn’t that hard to relocate. The official protocol is:

Step 1: un-plug the mySentry™ monitor from the wall.
Step 2: carry the mySentry™ monitor to its new location.
Step 3: plug the mySentry™ monitor into another wall outlet.

OK, I made that all up. It’s not really in the manual. But that’s all there is to it. No new setup. No new hassle. When you re-plug into the wall you get the Med-T teeter-totter logo, the startup jingle, and the Sentry finds the pump all by itself—and in no time your data is steaming in real-time.

Actually, over the last few days, the monitor has been showing up in all kinds of unlikely places in our house. Not only in my office, but also on the kitchen countertop while Rio and I played Lego Minotaur at the dining room table, and on the coffee table in the living room while we all watched Chitty Chitty Bang Bang as a family. (Did you know the original book was written by Ian Fleming of James Bond fame?)

But Sentry is most useful to me sitting on my desk, more or less under my nose. He makes it easy-peasy for me to multitask my fucking diabetes. Could I do it by leaving the pump on my desk? Maybe. But it would be a hassle, and the screen is painfully small. I probably wouldn’t pay any attention to it. And every time I stood up to refill my coffee, answer a cell phone call, pee, or whatever, I’d forget it was on the desk and the stupid pump would likely bang on the floor as I stood up. And what about the ol’ Dex? It’s a cordless standalone unit. Couldn’t it have worked as a commodities trader monitor? Nah, a Dex turns its fool self off after a few seconds, so it’s worthless on the desk. I’d have to stop writing to press a button to get any info. And then I’d have the opposite issue from the pump. When I left my desk to refill coffee, answer a cell phone call, pee, or whatever, I’d leave it behind, and if I got distracted and didn’t get back for a while, I’d be without my CGM alarms.


One of the things I love about having the Sentry on my desk is that it tells me when to eat. Yes, I frequently get so engaged in what I’m doing I lose track of time and meals. With my Dex gear, I’d get an alarm when I just went low. Ah, yes. I should have eaten half an hour ago. Shit. But now, with one eye on the Sentry I can clearly see my BGL starting to drift low, giving me plenty of warning that I need to wander out to the kitchen for sustenance.


In fact, I’ll be “write” back, I must go eat now. I’m at 108 mg/dl with a mild sloping drop. No predicted low yet, but I’m being proactive today.


OK, I’m back.

Once upon a time, years ago, I was interviewing a young lady for the position of my assistant. Towards the end of the interview, I cautioned her that the job description had a few unusual features.

She raised one eye brow skeptically, but remained calmly silent, her hands in her lap.

I explained that being a highly focused workaholic, I frequently forgot to do the most basic of things. Like stop and eat. Thus the unusual item on the job description: You have to remind me to eat.

She laughed, “Oh that I can do!”

Of course, I’m poorer now, so I can’t afford an assistant anymore. But the Sentry has filled my assistant’s role in this one fashion.

Hmmm… myAssistant may end up being the mySentry monitor’s name here at LifeAfterDx.

Next time: Dex vs. Med-T, how do they stack up against each other?

Saturday, March 24, 2012

Ultimate Cougar alert

I won’t live long enough to have sex with a grandma, but if I play my cards right over the next week, I think I might just be able to seduce a card-carrying member of the AARP.

(Be sure to read the name on the card)

Yep. Today my bride turns 50. And she’s none too happy about it, either. In fact, she was so traumatized by getting her offer to join AARP in the mail that she called me at the clinic: “Something terrible just happened,” she told me, her voice cracking slightly.

OhmyGod! Is Rio OK?!

My mind always jumps to the worst-case scenario.

Once assured our only surviving child was alive and well, I next asked about her mother; whether her car had broken down or suffered another flat—we drive them down to the steel belts; if phones or power had been shut off; or if she had bounced yet another check.

Nope. Nope. Nope. Nope.

“They sent me an AARP card in the mail,” wailed Debbie.

OK. I didn’t see that one coming. And my response didn’t help matters much. I said: Cool!

Movie, dinning, and lodging discounts here we come!

I don’t know why my wife is so bent out of shape about her age. She went through major meltdowns at 30 and 40; so I knew this one was coming. Last night, when she was moping about the house feeling sorry for herself, Rio asked me, “Is this the meltdown you warned me about?”

This is only the beginning, son.

So let’s talk about age. All biological organisms age. Of all the things you can and can’t control in your personal universe, this is surely the least controllable. But age is a funny thing. It is partly a matter of body, but also largely a matter of mind.

Looking around my personal universe, my quite spry 86-year-old mother is more active than… well, than me. She still drives cross-country, keeps engaged in world news and politics, and generally looks and acts like a woman 30-years younger than she is; while on the other hand, my 68-year-old mother-in-law has become frightfully frail and sometimes can barely walk across her living room safely.

In our electronic medical records at the clinic, under “physical exam” we have a drop down menu where we must select one of three options:

Patient appears stated age.
Patient appears older than stated age.
Patient appears younger than stated age.

Debbie hates, hates, hates to have her picture taken so I have no way to prove it to you today (plus taking pictures of your sleeping wife is a fast road to divorce, or so I’ve heard), but:

Wife appears younger than stated age.

So much so, in fact, that about a year ago I asked a middle-aged female colleague, who had met Debs for the first time the week before, Hey, what did you think of my wife?

Middle-aged female colleague (voice PURE ice): “She seems a little young for you.”

Actually, Debbie’s 1.5 years ahead of me, at least in terms of birthdays. When we were first dating, back when dinosaurs ruled the earth, Deb almost broke up with me when she found out I was a hair younger. My winning argument: I had more mileage; so the whole age thing was a wash.

I won that round and kept the girl. It’s always bugged her though, more so at birthdays, and even most so at the Big “O” birthdays.

But back to biology. She’s not really 50 today. Not biologically. Biologically she’s either a little bit older, much older, or a whole hell of a lot older—depending on how you look at it.

First, your birthday only marks the day you drew your first breath upon leaving your mother’s womb. It has very little to do with how old you are. Debbie’s body turned 50 nine months ago.

Or did it?

Did you know that a woman is born with a full magazine of eggs in her ovaries? So all of us actually are exactly as old as our mothers. The cells that built us start with that ol’ egg. When the egg gets used hardly matters, all the eggs are the same age.

So if you want to know your true biological age, look to your mother. Debbie isn’t 50. She’s sixty-eight. Or maybe 68 + nine months. I know what you’re thinking. You’re thinking that my chance of scoring with a certain card-carrying (under duress) AARP member just got pretty slim indeed. Bear with me. Because under those rules—egg age, not anniversary of first breath—I’m 86 years old. I’m 18 years older than my wife. I’m a fucking cradle robber! Sly dog that I am.

And if we really are concerned about our biological age, shouldn’t egg age be the barometer we use to measure it? The age of your oldest cell?

But wait. Is your first cell really the oldest part of your body? Maybe not. What about your mitochondrial DNA? Yeppers, your smallest chromosome is inherited from your mother. And she got it from her mother. And her mother got it from her mother. All the way back to Mitochondrial Eve, the common ancestor of every living soul on the planet. So maybe if we are looking to the roots of life, we’re all around 200,000 years old.

Some days I feel it, too.

Anyway, the whole physical age thing is a fallacy. What’s not so much a fallacy is what kind of shape we are, or aren’t, in at a given age. Debbie’s grandmother died in her mid-80s. One of the ICU nurses who attended to her cried when the grand lady passed on.

“It’s so sad,” said the nurse, wiping a tear from the corner of her eye, “she was still so young.”


Grandma had that perfect Hispanic skin that never develops a wrinkle. The nurse had mistaken her for 60. Debbie has that skin, too.

Other than the loss of Big Hair (it was the 80s when we started dating) my bride has changed very little in her physical appearance over the quarter century we’ve been together. Like some leading lady in a fairy tale or sci-fi movie, she seems trapped in time. Well, her face and body at least. Her keen mind wastes way too much time focusing on some number on her driver’s license. Or on her AARP card.

While time has been kind to my bride, the same probably can’t be said for me, although I have no complaints. I’m more weather-beaten. More lines and creases on my face, especially the little spider-web like ones around my eyes. Half my hair is grey, mixed in with the light brown. My beard, almost black when I was young, is shot with white now. Debbie claims I look better now than when I was younger. Maybe so. While women are more likely to obsess about youth, men are taken more seriously as we age.

How people look is a funny thing. Now granted, I was fired from my job at the circus after I lost the outfit too much money trying to guess people’s age; but it is harder than you might think. I work in an area of crushing poverty and that kind of poverty ages people quickly. I was surprised when I first started at the clinic that patients frequently underestimated my age by a decade or decade and a half. That’s because people around there who look like me are 15 years younger. By the time they are my age, they look 15 years older than I do.

So my ability to judge a book by its cover, never good in the first place, has gotten really worse over the years I’ve worked with the poorest of the poor. But where I work I have noticed something odd. From late 20s up to mid-60s, my patients look waaaaay older than their stated ages. The ones in their late 60s and 70s look about right. But then something magical happens. The ones in their 80s and 90s look younger than their stated ages. I had an 84 year old lady in my office yesterday that any of you would have sworn couldn’t have been a day over 60.

I don’t know it is. Maybe they ate healthier back in the day. Maybe they didn’t fall into the trap of drugs and alcohol (although to hear their spouses tell the tale, some of my oldsters really hit the bottle back in the day). Maybe the gene pool was stronger back then. Or maybe, by the time you are in your 80s, you have to be made of pretty tuff stuff to still be alive. Maybe the weaker ones have been weeded out by the Grim Reaper, only leaving us with the youthful elderly.

But it’s strange. One hour I’ll be staring into the withered face of a 40 year old who’s telling me of his assorted aches pains and inability to function as I review a med list of a dozen prescriptions that are doing a bad job of treating four or more serious chronic illnesses; and the next hour I’m staring into the pin-sharp twinkling eyes and smooth skin of a 80 year old who’s only complaint is “my knee bothers me a little at the end of a day of cutting wood.”

And I can’t tell you how many times Debbie has introduced me to some weather-beaten old hag at Wal-Mart and then later told me that she went to high school with her. Drugs, alcohol, poverty. They wear people down like sand paper.

And where do our brains come into play with our ages? Are we only as old as we feel, or at least only as old as we let ourselves feel? I know that Debbie feels old. I don’t know how much of it is what she feels in her mind or how much of it is what she feels in her body. I don’t know how much of it is her internal make up and how much of it is baggage from our society and her culture. I only know that when I gaze upon her face I’m getting a very different message than the one she gets when she gazes into the mirror.

And yes. I have had my eyes checked, thank you very much.

To me anyway, she doesn’t seem to get older. Only better.

So what did I get Debbie for this momentous birthday? Apparently I bought her a pretty new watch I couldn’t afford. She brought it home to show me the other day and told me what great taste I have. What a guy.

Of course we’ll go out to dinner tonight to “celebrate,” a.k.a.: drown her sorrows. And I also got her a birthday card. Ummm… a rather lewd card, actually. But as Debbie is so wound up in the effects and appearance of age this year, I decided that “I love you” was the wrong message to send. I decided the words she needed to hear was that I was still attracted to her. Still found her every bit as desirable as I did the day I first laid eyes on her. That the sands of time, which can flatten monuments and pyramids, seems powerless against her. In short: that I still lusted her after all this time.


Friday, March 23, 2012

The river of life

This is something I’ve been preaching for a number of years, but the message doesn’t seem to be making any headway. Not one to give up on my beliefs easily, here we go again: your blood sugar number doesn’t fucking matter. Period. End of sentence.

I don’t care if you’re at 49 mg/dL or 424 mg/dL. It doesn’t matter.

Not one teensy, tiney little bit.

It’s just a number. And as such, it doesn’t have any value at all.

But the context of that number means everything.

Consider the 49. Is it bad? Of course not. It’s just a number. It can’t be either good or bad. It’s just information, and frankly, not very good information, at that. Now, if I told you more, gave you some context to go along with it, then we would have something to work with.

Exhibit A: You took 12 units of Novolog 1.5 hours ago. Ten minutes ago, your BGL was 79 mg/dL. With that context you can safely say you’re in a world of hurt, and your life just might be snuffed out in the next ten minutes if you don’t take drastic action right now. You have a ton of insulin in your body, and it’s just reaching its peak action. If you do the math, you’ll see that you’re dropping at a rate of 3 mg/dL per minute. With no intervention in ten more minutes you’ll be at 19 mg/dL, pass out, have a seizure, and die.

Exhibit B: You just took first place at Dancing with the Stars. During the grand finale you really worked up a sweat dancing the Lambada. Or was it the Paso Doble? At any rate, as even your mother could have predicted, you waltzed your way right into a hypoglycemia. A pretty bad one, in fact. You bottomed out at 38 mg/dL. But you have a trophy to pick up. Luckily for you, you had the presence of mind to put some glucose tabs into your dancing shoes, which you just took five minutes ago. The glucose. Not the shoes. Well, in this scenario the 49’s not so scary any more. Hell, you’re supposed to wait fifteen minutes after taking the glucose before you test again anyway, not five. Not that I blame you. It would be embarrassing to pass out on national television, after all. Especially in your moment of glory. But in only five minutes, you’re already up by 11 points. Sure, you’re still low, but you’re on the rebound. Mission accomplished. There’s nothing more you can do at this point but wait.

I could just as easily create to “good” vs. “bad” scenarios for the 424 mg/dL but I won’t waste your time.

This is where CGM trace screens rule and rock. A trace screen is a graphic representation of blood sugar over time. It looks like a stock market report. The vertical axis is the level of blood sugar, typically from 40 to 400; and along the horizontal axis is time—it can be three hours, six hours, 12 hours, or 24 hours. Over on the right-hand side is where your blood sugar is now. A connect-the-dots line, called a trace, shows the meandering of your blood sugar over the time period.

Trace screens are your new best friend.

Once you get the hang of reading them, they are the fundamental, indispensable tool for helping you navigate your diabetes. Hell, they’re nothing short of blood sugar GPS.

At a mere glance you can know where you are, and how you got there. Try that with an isolated number on a BG meter! This is why I get so hot under the collar when some people get on a rant about their CGM not 100% syncing up with their meter. Never mind that the meter’s accuracy sucks in the first place, even if meters were 100% accurate, a single number is powerless compared to the flood of informational context you get out of an even moderately accurate CGM.

I think a good comparison is to the instrument panel of an airplane. I used to fly back in the day (the day being pre D-day), and I even have a dusty un-usable commercial pilot’s license to show for it. Now, the instruments in the cockpit were designed to give you some quick information about your aircraft at a glance. You didn’t need to think about what they were telling you. You didn’t have time. You were busy flying the damn plane. Simply sweeping your eyes across the various instruments can quickly tell you some important things like if your plane is up-side-down or right-side-up, if the engines are still running, how close to the ground you are, and how much gas is left in the tanks.

A CGM trace screen tells you the same thing. It’ll show you, at a glance, where your sugar is at, where it was a while ago, and how rapid the change is. That last part is what dictates your response. Rapid changes require quicker and more desperate action than slower changes; and rapid changes—graphically—are shown by steeper lines on the CGM.

Consider these two low blood sugars that mySentry has recorded in the last week:

I’m below target at 80. Now, I really don’t like being below 100. Ever. Being hypo unaware and all. The readout shows a drop from about 200 over the last hour and a half. That’s a drop rate of 1.3 mg/dL/min.

I’m still above target at 101. But note the double-down arrow to the left of the BG readout at the bottom of the screen. Yeppers. I’m still dropping like a fucking stone. The readout shows a drop from about 275 over the last hour. That’s a drop rate of 2.9 mg/dL/min.

Which CGM trace should worry me more? Right! The one with the steeper curve, the sharper, deeper line—showing faster change. You don’t even need to do the math, the sharper the line in the vertical direction, the faster the shit is hitting the fan.

Especially with lows, faster lows… well, technically, faster drops… are more serious, and require more sugar to stop and reverse. Slower lows are less serious, as you have more time to fix them. Generally, but not always, fast drops are associated with waaaaaaay too much insulin while slower drops are associated with only a little too much insulin.

As I’m sure you can imagine, my response to the two lows above was very different. Of course, CGMs also have rate of change alarms, so you can get a head’s up to a steep drop long before it gets low at all.

All the CGMs on the market today have trace screens on the receivers, but they’re limited in size by the size of the device, Med-Ts being a fair bit smaller and lower resolution than Dexcom’s. That said, I always found both of them more than adequate.

Until now, damn it.

It turns out that bigger is better, after all (and I always suspected they were lying to us about that all these years). The much, much, much larger CGM trace screen on the monitor of the Sentry is fucking awesome. At four-and-a-half inches wide and three-and-a-quarter tall, it’s a good 300% larger than the screen on the Revel pump. Oh and it’s resolution is better, too. And it has come color, something I regarded as frivolous at first, but have become quite addicted to. Ummm… That said, however, I think Med-T could have used the color in a smarter way. On the monitor, the glucose targets are thin red lines, the hour line and the trace are both white, on a grey back ground. As I think I mentioned yesterday, the status icons for battery, insulin, telemetry, sensor calibration and sensor age all change from green to yellow to red. I’m good with all that, but I think Med-T missed an opportunity when it came to the alarms. The various “Glucose Alert” screens that pop up when the pump sends an alarm to the Sentry are basically B&W. It would have been cool if falls and rises had been in yellow and low and high alarms flashed red.

Sorry, I got off topic there. But the big screen is awesome, it makes it so easy to take in what’s going on in a glance. And more. The larger screen lets me see finer detail. I’ve used it to judge hypo recovery. Ah…. see that! The trace line is flattening out! The recovery is underway. No need to take more glucose!

I’m using the Sentry to manage my personal diabetes crises in real time.

Next time: A different kind of day at the office.

Thursday, March 22, 2012

Good morning sunshine

I yawn. Stretch. Rub my eyes and reach for my glasses. I glance at the Sentry on my nightstand.

Pump battery: full.
Sixty-nine units of Novolog in the pump.
Signal strength between pump and Outpost: so-so but not horrible.
Next CGM calibration due in three hours.
One day remains on the sensor.
My BGL is 125 with a slow and steady drop over the last two hours.
Over the last six hours I’ve been in target.

I’m not kidding about the glance, I got all that info in a glace, displayed in real-time, at the same time, on Sentry.

All the information is displayed via a graphical interface. Like an old-fashioned analog watch, a glance will tell you what you need to know without having to really engage your brain. To do this, Med-T used logos that change color. For instance, my battery icon is green, but my little insulin vial is now yellow. My insulin is getting a little low, but it’s not an emergency. When it gets too low, it’ll turn red. The same color scheme of green-yellow-red is used for the battery strength, insulin level, signal strength, sensor calibration, and sensor age. The blood sugar information is displayed in a “trace line.” Learning to read the blood sugar trace lines, and understanding the story they are telling, is something I have a lot of experience with; and it’s something that I’m going to teach you if it kills both of us. But we have lots of time to worry about that later. Like, say, tomorrow.

One thing I like about mySentry, is that it stays the fuck put. Whatever screen I leave the thing on, it stays there. This is no small deal to me. Take the Dexcom Seven Plus for instance. Not only will it not stay put, it won’t even stay on. The philandering bastard turns itself off after a few seconds and always defaults to the three hour screen when I wake it up again.

Sentry remembers my preferences. It’ll stay on any screen I choose, and it has a number to choose from. I can operate from my three hour, six hour, 12 hour, or 24 hour glucose trace screens (all quite usable, given the large size of the Sentry’s screen—we’ll talk about which one makes the most sense on another day). Or if I was an idiot, I could just look at my current glucose reading in HUGE type font as if Sentry were an over-grown blood glucose meter rather than a CGM. Or I can blackout the glucose info altogether and just have the pump status displayed. This is called a privacy setting. Nice thought, I guess, no one likes to be in their underwear when company shows up, and letting everyone and their uncle see your blood sugar is pretty much being naked, isn’t it?

Now I promised you we’d cover the operation of the monitor in more detail, so here we go.

On the top is a bell with a spear though it’s heart. That’s universal button language for “mute” or “silence” or “shut the fuck up” (depending on the hour of the day). In small print in plain English above the logo it says “Silence Alarm.”

This button is used to silence an alarm on the monitor. Duh. Note that this doesn’t cancel the alarm, that can only be done from the pump itself. The bell-button can also be used to silence the whole unit when you are going to be away from the system for a while, so it won’t drive your type 3s batty when you go to work.

On either side of the screen are three buttons. On top left side is the Eye or Rah (or maybe it’s the Masonic Eye, I’m not sure). Below that is either the mathematical symbol for “less than” or a left turn arrow, depending on your education and background. On the bottom left is a snowflake. Top right is an “up” arrow, in the middle is a funky Pac-Man-like logo, and on the bottom is a “down” arrow.

The Eye of Rah is called the “View” button by Med-T. It’s used to get the main menu and to scroll through the various glucose screens we talked about a few minutes ago. The main menu has two sub-menus, one is the Utilities Menu where you go for initial setup—linking the pump and Outpost to the monitor—as well as for adjusting nightlight brightness, screen brightness, and alarm volume. There’s also a network status screen on the main menu were you can check out the telemetry strength of the signals coming in from the Outpost and from the Pump itself. According to the manual, there should also be an alarm history menu, but this function appears not to be working on my unit. The alarm history has never appeared for me, regardless of how many alarms I get.

The left turn arrow is called the “Back” button by Med-T. Its main function is to let you scroll back along a glucose trace to check the exact sensor glucose reading at a point in the past.

The snowflake turns on the nightlight on the back of the unit, something I haven’t used yet, as even dimmed to the minimum, the screen is still quite bright.

On the right, the Up and Down buttons work like you’d expect, letting you scroll between the three, six, 12, and 24 hour sensor trace screens, and letting you navigate up and down the Utilities Menu. The Pac-Man in the middle right is called the “Next” button by Med-T. It’s used mainly for selecting menu items.

Depending where you are amongst the various screens, not all the buttons function, so they are lit when you can use them, and they “dim out” when they’re not available.

And that’s pretty much all there is to it, I find myself poking Rah in the eye and telling the Sentry to shut-the-fuck-up more than I use the other buttons; but it’s not rocket science and once you’ve been around the block a time or two, it’s very intuitive. I predict the user’s guide will collect a lot of dust after the first read-through.

Next time: A whole lot more about trace lines.

Wednesday, March 21, 2012


Stock Tip: If you have a lot of hair-dye stock, I’d sell it now. If nothing else, Med-T just cured the grey-hair epidemic amongst parents of T1 children.

So I’m sure everyone can clearly see by now how mySentry might benefit the parent of a little type 1, especially at at night. Because now, thanks to the miracle of modern technology, these poor people might just get a full night’s sleep before their kiddo turns 18 and goes off into the world.

But I’m sure some of you are wondering why an adult type 1 like me would be interested in this system. After all, in essence, it’s just a remote monitor for a pump that’s not in motion. What possible good is it to an adult with diabetes?

Well, there’s really no delicate way to say this, so I’ll just jump in with both feet: I suffer from both a dysfunctional body and a dysfunctional marriage. My body is hypo unaware. I don’t feel my low blood sugars. At all. This is especially dangerous at night when I’m asleep, and that’s where my dysfunctional marriage comes into play. I sleep alone.

Now I don’t want to depress any of you single-but-looking, or divorced, T1s any more than you already are—but your mortality rates are shockingly higher than those of married type 1s (whose spouses sleep with them).

The reason? The nocturnal Hypo Reaper. Lows kill and they kill most often at night. Ask the spouse of any veteran T1 and I pretty much guarantee you that they’ll have a hair-raising nocturnal story or two of how they saved their T1’s bacon.

I’ve lived this long by making lots of compromises. The original garage door opener Guardian was loud enough to wake me in my sleep. After it was discontinued, the newer transmitters wouldn’t work with it. I liked the next generation of the Guardian a great deal, with its predictive alarms, trace screens that showed the pattern of blood sugar in a graphic way, and its ability to set different alarm thresholds at different times of the day. But her low voice led to some close calls. I ended up switching to the louder system made by Dex that lacked many of the features I liked.

Over time I’ve come to miss some of those features, as well as get burned out on the volume of gear I carry, and how poorly the various parts of my life support system talk to each other. As soon as I read about mySentry, I wondered if it could be the solution to my problem. Could it be a diabetes stereo system with a great amplifier?

Bottom line—I’m hoping mySentry will solve the volume issue that is Achilles Heel of the current Med-T CGMs. I hope it will make the system safe and usable for me.

That’s part of it.

And the other part? Well, I’m the original CGM guy! I didn’t want to miss out on the next chapter of CGM—the ability to send CGM data somewhere else in real-time and what we might do with that real-time data when it’s out of the box on our belts and into a box somewhere else.

Next time: Real-time disaster coordination and planning.

Tuesday, March 20, 2012

I read you LOUD and clear

This is just fucking perverted. It’s well after midnight, and we’re all gathered around mySentry: waiting, hoping. God help me, we’re waiting and hoping for a low.

My blood sugar is coasting right above my nocturnal low threshold, set at 80 mg/dL. Actually, even more perverted than this scene, a scant 30 minutes ago we got a predicted low alarm which I treated sub-therapeutically. In other words, out of morbid curiosity to hear the low alarm, I took less glucose that I should have for the threatened low. I slowed the decent, but didn’t stop it.

Piling sacrilege on sacrilege, I was not only letting myself have a low, I didn’t even use glucose to slow the decent. I used corn syrup. Yep. Candy instead of medicine. I’m such a rebel tonight.

Now, for background, and this is only true of Med-T CGMs—so you Dexcom users aren’t allowed to feel bad about this—if you use a Med-T CGM right, you’ll never hear the low alarm. Ever. That’s because their predicted alarms actually fucking work. I mean, it’s not rocket science: you have a target blood sugar, you have the speed of the drop, the math involved in predicting in advance when you’ll cross the low threshold isn’t that hard. But the effect is magical!

Actually, I like to joke that predictive alarms never, ever work because they work. Yeah, I grant you, it’s a Catch-22 type situation. When you get a warning that you are going to be low, you have time to prevent it, so you never end up actually going low in the first place (or is it the second place?). At any rate, the CGM accurately predicted an event that will never come to pass. So it really wasn’t accurate, was it? Or is it? It’s like one of those head-exploding sci-fi paradoxes when you go back in time, and your time machine lands on your grandfather’s head, killing him… so you couldn’t have been born… but if you weren’t born you couldn’t have traveled back in time and squashed his head… but if you didn’t travel back in time and squashed his head you would be born after all so… Yeah. One of those kinda things.

But I digress. In the interest of science and journalism, tonight, we’re letting this low happen.

Back to the story.

It all started at nine minutes after midnight, at the end of a hell day, just as I was closing my eyes for some much needed sleep, Sentry cleared his throat for the first time and said:

DaDoo. DooMa. DohRa.
DaDoo. DooMa. DohRa.
DaDoo. DooMa. DohRa.

Or words to that effect.

Loud enough to scare the shit out of me, thank God. Great start! The screen lit up with “Low predicted. Sensor Glucose approaching low limit. Check BG now.” It’s always nice to have a check list to remind you to put on your parachute as your plane goes down in flames over enemy lines.

While loud, the tones aren’t scary like Chernobyl meltdown alarms, not ear-piercing like fire alarms, not annoying like car alarms. They are, in fact, very musical.

But now words fail me. After all, there’s no way to write what a Bach violin concerto sounds like. The constants and vowels of the English language are ill equipped to relate to the mind the tones and sounds of music to the ear. And that’s what Sentry’s alarms are. They’re musical. They’re loud and pure tones from a xylophone. Throaty, but each note clear and strong, ringing with a bell-like resonance. Each syllable a full octave below the one before the last—bells descending

And then, 45 minutes after midnight what we were all waiting for happened—after one downslope alarm and three predicted lows—


Hmmm…. But reading what I just wrote makes the alarms sound oriental in flavor. It’s an odd music, but not oriental. Maybe it was Bong-rong-tong? Maybe it was more of a dong than an a bong. Or is it a thong?


I give up. Go rent a xylophone if you want to hear what the mySentry alarms sound like.

But the good news is that the low tone is different from the predicted low, which is different from the fall rate, or downslope alarm. It’s still a descending tone, but it’s faster paced. More frantic. It’s still friendly. Only more throaty. More urgent.

mySentry’s alarms are not as fun as old garage door opener Guardian’s were, with her air-raid sirens and alien invasion sound effects, but still… They are loud enough and each speaks its own language.

I downed a Dex4 fluid, turned my light out, laid my head on my pillow, pulled up the covers and snuggled in for the night. Outside, I heard Coyotes yipping in the distance, a nocturnal serenade.

I wonder if Coyotes can sense low blood sugar like they say some dogs can? Hmmm… and what about Wolves, and tigers and lions and bears… Nah.

I think I’ll stick with technology for now.

Next time: and you’re doing this because?

Monday, March 19, 2012

You don’t have to shout. Oh, Wait. Yes. Yes, you do.

I’ve said it a hundred times, but I’ll say it again: a CGM alarm needs to be loud enough to wake the dead to prevent you from joining them.

As a quick review of the history of CGM alarms, the original 2005 garage door-opener Guardian had awesome alarms. It squawked and vibrated at the same time, if you wanted it to (and I did). It had a wide range of volume options. I kept mine on MAXIMUM. The alarms had personality, in spades. Highs sounded like air-raid sirens. Lows sounded like invading flying saucers. If you ignored an alarm for too long it changed to the Ree-roo. Ree-roo. Ree-roo of European police cars.

I loved the sound effects. When I got an alarm I already knew what to do before I even had to look at the damn box. So, too, did my loved ones and co-workers. An alien invasion alert at the clinic was like a nurse pager: they came running with glucose tabs. On the other hand, an air-raid siren set me up for much good-natured teasing about “what did you eat this time?”

But, sadly, volume was inexplicitly dropped as a priority as Med-T moved on to the Paradigm Real-Time, then to the up-graded up-dated Guardian, and on into Revel. Volume—the most critical aspect of a CGM alarm system—became an afterthought. What the fuck’s up with that? I’m told the volume was limited due to the “water proofing” of the pump cases used in these machines.

Bull feathers.

A Med-T pump is only splash resistant to start with. My dive-certified Timex Expedition watch, which set me back all of thirty bucks, has an alarm five times louder than the Med-T systems.

Another time that I was whining about this, I was told that it had to do with the batteries. The old Guardian used a pair of... well, now I don’t remember if it was double-A or triple-A batteries, but there were two of them. The newer machines only use one so, this person claimed, didn’t have the juice for louder alarms. This was also cited as the reason for the fact the alarm tones were not only lower in volume, but shorter now, as well.

Double bull feathers.

Well, this person went on, even if it could be made to pull more juice out of the single battery, the batteries would go dead sooner (same excuse for Paradigm’s automatic time-out screen on the CGM status).

Triple bull feathers. I can buy triple-A batteries by the pound at Sam’s Club.

Someone, somewhere, blew it. And if I ever meet that person, I’ll slap them.

The diminished alarms were so bad that I viewed them as life-threatening. And I wasn’t the only one. While Med-T sales reps were advising people to set their pumps on vibrate and place them next to glasses of water on the nightstand at night (are you fucking kidding me?), ingenious parents were super-sizing baby monitors by undertaking Frankenstein-like operations to mate them to stereo amplifiers.

Volume, well lack of it, was one of two deciding factors that lead me to drop Med-T CGM in favor of Dexcom back in 2009, despite the fact that the Dex device was (and still is) arguably more primitive. The other factor was, that at the time, the Dex sensors seemed more “on the money;” something that sadly has eroded significantly over the last six months.

So needless to say, one of the two things I want most is to hear Sentry speak for himself. I wonder, wonder, wonder what he’ll sound like. Will he be loud? Will the alarm tones be long enough? There are no excuses. Sentry isn’t water proof. Sentry doesn’t use batteries, he plugs straight into the wall. Will the different alarms have different personalities? Or will they being boring same/same?

The suspense is fucking killing me.

Next time: Sentry introduces himself.

Sunday, March 18, 2012

The dance

Famous dances in history:

The Dance of the Sugar Plum Fairy.

The Waltz.

The Tango.

The Jitterbug.

The Samba.

And my personal favorite, of course, the Dance of the Seven Veils.

But most of these dances only involve one or two dancers. The Sentry dance is more like a line dance, a square dance, or the Macarena (hey, it lives on at weddings): it involves a number of dancers spinning across the floor together. We briefly touched on it yesterday, but just to be clear on everyone’s job description:

The sensor talks to the transmitter.
The transmitter talks to the pump.
The pump talks to the Outpost.
The Outpost talks to the Sentry.

The shine bone’s connected to the knee bone.
The knee bone’s connected to the thigh bone.
The thigh bone’s connected to the hip bone.
The hip bone’s connected to the back bone.

Got it?

Oh. Wait. Crap! I forgot. The thigh bone can also talk directly to the back bone without going through the hip bone. I hate it when my clever little analogies break down so easily.

This is because Sentry is bilingual. It can talk to both the pump and the Outpost, which themselves don’t speak the same language. Well, saying that the Sentry can talk at all is inaccurate, I guess, as the Sentry is more of a passive listener.

The pump broadcasts its status and its alarms in ultra-high frequency, at 916.5 megahertz. The Outpost speaks to the monitor in different ultra-high language, all the way up at 2.4 gigahertz.

The lower 900 megahertz range of pump-speak is where you find most “cordless” landline phones operating (don’t let the numbers fool you, remember that “giga” is a factor of 1,000 larger than a “mega”); while the two-and-a-half gigahertz range of Outpost-speak is inhabited by wireless computer networks and microwave ovens.

Uh…microwave ovens?

Does that mean the Outpost might fry your little T1’s brain in her sleep? The mySentry manual assures us that “providing that it is used at distances greater than 7.9 inches from the human body” the Outpost is not harmful. (Apparently exempted from the 7.9 inch rule are your hands and wrists.) The manual goes on to quickly point out that the powerful Outpost is still only packs a punch one-tenth the power of a typical cell phone, and that on top of that, the Outpost works in a burst mode, sending out a signal every five to seven minutes. Not that Med-T’s lawyers were worried, or anything.

Still, to be honest, I think you have much bigger things to worry about.

But while we’re on the subject of how these devices communicate, why the difference in language in the first place? Well, even though both signals are scientifically in the “ultra-high” frequency range, the higher (and newer) gigahertz signal carries further in devices of this size. The Outpost speaks the higher frequency simply to give it the greater range it needs to boost the signal so it can be heard by the Sentry at distances of—according to the manual—p to 100 feet away inside your house. I suppose actual range would depend on how well or how poorly your walls are made. I live in a 40-foot mobile home. I’m pretty confident the Outpost can easily reach every nook and cranny in my house and probably out onto the back porch and well into the cactus garden with no trouble at all. The issue of course, is not so much the Outpost’s performance, but the fact that the stupid pump needs to be within a few feet of the frickin’ Outpost in the first place for the Outpost to pick up the signal at all and pass it on.

But here’s where things get interesting. Remember that I told you the Sentry was a bilingual listener? Right. It can hear not only the Outpost, but it can hear the pump itself. Directly. With no Outpost involved. Assuming that Sentry, too, is within six feet of the pump. This is actually a wonderful feature that we’ll talk a lot more about soon. But for now, just know that, no hip bones required, the Sentry can listen to the pump speaking in its native tongue, or it can listen to the Outpost’s much louder voice. And either way it can learn about, and relate to you, the following things that are happening in pump land:

(OK, come to think about it, the Sentry does “speak,” it’s not limited to listening only. While Sentry doesn’t speak to the pump or the Outpost, it speaks to us. It speaks Human.)

It can tell us: What your blood sugar is in real-time. Well, so long as we define real-time to be within the last seven minutes. It can tell us what your sugar has been up to 24-hours previously. It can tell us how fast the sugar levels are changing. Whether they’re going up or down. How strong the pump’s battery is. How many units of insulin are still in the pump. What the signal strength is between the CGM sensor and the pump. When the next CGM calibration is due. How much life is left in the sensor. It can also relay all CGM alarms from the pump: drop or rise rate alarms, predicted highs or lows, and honest-to-God highs and lows; as well as many—but apparently not all—pump alarms, too.

OK. So much for the dance of the components with each other. But now the real beauty begins: How the whole system dances with us.

Next time: Eagerly awaiting an alarm.

Saturday, March 17, 2012

What came in the box

So before we really dig into our story, we need both a common language and an understanding of the cast of characters in our ongoing drama. Or maybe it will turn out to be a comedy. Hopefully, not a tragedy. But, as Shakespeare said, “all the world’s a stage…”

The Cast of Characters (Working outwards from the skin to the nightstand):

The sensor

Technically called the Sof-Sensor Glucose Sensor (registered trademark, yada yada yada—Med-T is a ®©™ happy company), this is the needle-like miracle of modern technology that nestles in your subcutaneous body fat, bathing in interstitial fluid for an FDA-approved period of three days. Of course, these bad boys are expensive with an official retail price $42 each, so no one in their right mind wears them for only three days. Six and nine are the most common wear-lengths, although I found one crazy person online claiming to have worn one for nearly a month. We’ll talk a lot more about the wear-length issue later. The Sof-Sensor is the first-gen workhorse of Med-T CGMs, being originally FDA approved waaaaaay back in the summer of 1999. It’s been on point through about six generations of their gear, depending on how you count generations. The sensor is a microelectrode, made of, no shit, gold. It’s then coated with glucose oxidase, enzymes, and several layers of “biocompatible membranes.” So really, it’s nearly a living thing with a heart of gold. Using the magic of bio-electrical-chemistry it can determine the relative level of glucose floating around in the water between your cells. The sensor is the star of all CGM systems, it’s what makes CGM possible. The basic structural design of the Sof -Sensor hasn’t changed for over a decade, but improvements to the coating process and smarter algorithms in the gear that interprets the sensor’s data have improved accuracy a great deal over the years. The sensor slides under your skin with the aid of a large-ish guide needle thats then removed. A flat clear-purple plastic hub remains on the surface of your skin, stuck firmly in place thanks to a thin sticky-tape pad. The hub has a connector for the next actor:

The MiniLink transmitter
Hence forth simply called either the CGM transmitter, or more commonly here at LifeAFterDx, the “seashell” due to its resemblance in size and shape to something you might find on the beach. It’s an aerodynamic rechargeable device that snaps onto the sensor’s hub. The seashell both stores, and wirelessly transmits, sensor signals to some other device, in this case the:

The Leading Lady—the MiniMed Paradigm Real-Time Revel Insulin Pump

A name which does not fit on the marque, so I’ll simply call her the Revel or simply the pump—at least until such time as she reveals enough of her personality to me to rate an official LifeAfterDx name. Now insulin pumps are pager-sized devices that… What? Oh dear. That’s right. I’ve been writing about insulin pumps for so many years I’ve forgotten that pagers have gone the way of the pterodactyl and the stegosaurus, and that most young people have no clue what a pager is, or what size it was. Hmmmmmm…. give me a second… Ah! OK, a pump is a cigarette pack-sized electronic device that makes insulin delivery a helluva lot easier and more accurate. The pump carries fast-acting insulin only, covering the body’s basal needs with a constant pre-programed variable drip, and delivering more insulin on demand for meals and corrections. It doesn’t do much of anything automatically. Pumps aren’t smart. A pump might replace your pancreas, but it doesn’t replace your brain. It’s just a fancy syringe. Although technically part of the Paradigm line from a few years ago, the Revel is a very different beast on the inside from its predecessor. Better menus, more sophisticated CGM features… I’ll talk a lot more about this later. The pump doubles as a display monitor for the CGM, so although we often refer to such systems as “CGM enabled pumps,” it’s really not true. The relationship is more parasitical than enabling. The CGM controls no pump functions at all here in the States. The pump simply displays CGM data and serves as home base for the CGM alarm system; but as such, results in one less box on my belt, and that scores a lot of points with me. The pump has an entire supporting cast of its own including the disposable infusion set made up of an insulin reservoir, tubing, a connector, an insertion site assembly, and a cannula to deliver insulin through your skin and into your body. She also has a consort in the form of a dedicated blood glucose meter that can whisper in her ear. The meter, too, has own supporting cast of strips, lancing device, lancing needles, and a horribly large belt case. But for now, know that like a game of Grapevine, the Revel takes the CGM signals and passes them on to:

The Outpost

So Med-T had a problem when they wanted to develop a remote monitor for their pumps. The problem was/is that the transmitter in the pump isn’t worth a crap, largely because it never needed to be worth a crap. It’s original function, I imagine, was to transport data from the pump to a computer system for analysis. You don’t need much of a transmitter to do that. In point of fact, the transmission range for the Revel pump is around six feet. A supermodel wearing a Revel in her bra can barely transmit her data to the floor she’s standing on. So what to do? The solution is one of two parts of the mySentry system (technically there are three parts, but one part is just a power adapter)—a signal-booster called the Outpost. The Outpost is about the size of a nightlight and plugs right into a wall plug. Actually, it doubles as a night light. And, I gotta say, the Outpost is a cute as a button. But I think I need to be very clear about what the Outpost is not, more than what it is. It does not turn your home into a CGM wireless hotspot that’ll pick up your pump’s CGM signals as your roam around your house in your underwear. The Outpost is a powerful signal booster, but it’s boosting a weak signal. The Outpost will amplify a Revel’s anemic signal and send it up to 50 feet away; but to do so it has to be within six feet of the pump to hear the signal that it’s going to boost and pass on to:

The Leading Man—the monitor

Oddly, this heart of the mySentry system doesn’t have a registered trademark name at all. It’s only known as the monitor, or MMT-9101 to its friends. And even though mySentry is technically the name for the whole system: monitor, Outpost, and power supply, as the monitor really is the one that stands guard, I’m going to call it the Sentry here at LifeAfterDx. The Sentry looks like a Star Trek: The Next Generation sickbay device stuffed into a 2001: A Space Odyssey box. It’s old-fashioned modern-looking if you know what I mean, about seven inches left-to-right, and five inches tall. The buttons are flat, smooth to the touch, but not at all like a modern Apple touch screen. Sentry was designed and sent for FDA approval long before iTouch technology even existed in a basement at Cupertino. Still, the ghostly buttons are responsive, requiring only a whisper of a touch to operate. The screen is color, and shows what’s happening in Pump Land. In the coming days we’ll talk about every button, every screen, every feature, and every noise this gentleman can make.

The supporting cast includes:

A triple-A powered charging unit for the seashell, a USB antenna for downloading the pump to a computer, a belt clip or holster for the pump, a test plug for the CGM, a horribly designed inserter for the CGM sensors, manuals, quick-start guides, batteries and more round out the cast—and I’ll introduce you to each of them later, as they make their appearance on the stage.

Next time: the Dance. Or how all the parts play together.

PS: happy St. Patty’s Day to all of you people green with envy.      ;-)