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

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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!).

Thursday, April 19, 2012

High odds. Higher stakes

The Pope called me today. Apparently I’m in the running for Patron Saint of Insulin Pump Failures. But he has some concerns about the results of my back-ground check… something about exceeding the maximum number of allowable skeletons in the closet.

Anyway, I think you all know where this is going. I don’t blame you if you don’t believe it. I’m living it, and I don’t believe it either. But even though you can all guess the terrible ending of this day, let me tell you the story as it unfolded, because Revel the Fourth (lousy used piece of crap she is) saved my life today before she, like her sisters, gave up the ghost.

Our tale begins with the low. It was breathtakingly fast. A blitzkrieg hypo. No warning. Too fast even for my drop-rate alarm to wake up the situation. The rug was pulled out from under me in a split second. Hell. The whole damn floor was pulled out from under me in a split second.


The sensor was clocking a 120 when it predicted the low. My low threshold at this time of the day is set at 70. I use a 20-minute warning alarm in the predicted alarm settings, so for Revel to call a low while still above 100 means I’m dropping like a rock on Jupiter. At the time, I only realized it was fast; when I crunched the math after it was all over, it came in at a drop of more than two-and-a-half points per minute.

That’s a pretty fast drop, folks.

Oh. Did I mention I was on the road at the time? Yeah. Driving to Albuquerque for a meeting of the state’s Diabetes Advisory Council.

Of course, brain starved for glucose, I wove from lane to lane, getting out the meter, lance, and test strips—half of which spilled out of the vial and onto the floor. And in true diabetes road warrior style, I held the steering wheel with my knee, and with one eye on the road and one eye on my right index finger, tested my blood sugar.

I was already at 72 mg/dL. Forty eight points lower than the CGM was showing.

Then, still, not pulling off the road like a sensible person, I fished out a vial of glucose tablets (Tropical Fruit Flavor!) from the glove box, and started eating.

Chomp. Chomp. Chomp.

Drive for five minutes. Test blood sugar. No rise.

Chomp. Chomp. Chomp.

Drive for five minutes. Test blood sugar. No rise.

Chomp. Chomp. Chomp.

I got it back to up to 85mg/dL in about 32 miles. At first, I was mainly annoyed. I had woken up late and ran around the house like a crazy person, shouting at the cats and blaming my spouse for not waking me when she promised to. I was pretty high when I woke up, but still, that’s no excuse for bad behavior.

I took a correction, but obviously something went wrong over the next two hours. Astute readers will say, wait a minute, Wil, you’re always bragging about how great these predictive alarms are, but you just got bit in the butt. Your stupid CGM thought you were at 120 when you were already at 72. The anti-CGM crowd is already harrumphing me. Actually, I got no complaints at all. Other than about my traitorous body.

We need to judge CGM in proper context.

So let’s go back to the basics here. CGM’s don’t get to play in your blood. They park their expensive little asses in your interstitial fluid, the water between your cells. There be glucose in them thar fluids, but i-fluid is like my wife: late to all occasions. When blood glucose goes up, i-fluid follows. In a little while. When blood glucose goes down, i-fluid follows. In a little while. When your blood sugar is stable, the glucose in the blood and the i-fluid are very close.

So like the front and last car of a roller coaster train, blood glucose and i-fluid glucose will follow the same track: but the lead car and the end car are never at the exact same place at the exact same time. And that’s what makes predicitive alarms so great. They let the rider in the last car see where the rider in the first car is at.

I think the other day I said something stupid like “if you use your predictive alarms right, you’ll never go low.” Oops. So here I am low, predictive alarms and all. Lower than shit on the interstate. What do I have to say for myself?

I say thank God I wasn’t wearing my Dexcom today.

Because the Dex only has threshold alarms. That means I wouldn’t have gotten an alarm unitl I went below 70 on the CGM. Of course with the speed of the drop, we know the sugar was 48 points lower than the i-fluid. By the time Dex would have given me an alarm, my blood sugar would have already been at 22mg/dL. The paramedics would wonder what that funny noise coming from the wreckage was all about.

Instead, I arrived safe and sound in Albuquerque, feeling pretty damn good about Revel and Med-T CGM systems. Right up unitl sixteen minutes after 12 noon.

Motor Error, said Pump the Fourth.

I’m not sure how to describe the waves of emotions that crashed over the beaches of my soul at that moment.

Now, I’m not sure if I explained this or not, but a Motor Error isn’t one of those by-the-way alarms, like the red “maintenance required” light on your car’s dash board, that you can just ignore. When you get a Motor Error on a Revel, the pump has stopped. Your life support system is no longer on the job. And the only way to re-start the pump is to pull out the reservoir, rewind the pump, put the reservoir back in, and re-prime the system.

That means you have to unhook or risk a bonus bolus you don’t need.

And that means if you are sitting in the front of a very crowded room during a presentation about osteoporosis and diabetes, you have to get up and slip out of the room. With all eyes on you.

Down the hall, in the handicapped bathroom (the closest one), I disconnected my infusion set, removed the reservoir from the pump—calling it a fucking piece of shit—and rewound the pump. Then I re-inserted the reservoir. Locked it into place. Pressed ACT. Confirmed I was disconnected by arrowing down to “Yes” and pressing ACT again. Then I held the ACT button down to move the plunger forward, the pump chirping the whole time. Once I saw a drop of crystal clear Novolog at the tip of the tube’s quick disconnect, I told the pump, that yes, I see drops by arrowing down to “Yes” and pressing ACT. I then had to press ESC to bypass filling the cannula, and then twice more to get the home screen, and then a third time to get to my CGM screen.

Then I had to sneak back into the conference.

143 minutes later, at 1439 hours, during a presentation on a new curriculum for teaching healthy eating habits to fifth graders Pump the Forth said:

Motor Error.

Once again, all eyes on me (I’m so sitting in the fucking back row from now on) I got up in the middle of the speaker’s presentation and slipped out of the room.

Down the hall, in the handicapped bathroom (the closest one), I disconnected my infusion set, removed the reservoir from the pump—calling it a fucking piece of shit—and rewound the pump. Then I re-inserted the reservoir. Locked it into place. Pressed ACT. Confirmed I was disconnected by arrowing down to “Yes” and pressing ACT again. Then I held the ACT button down to move the plunger forward, the pump chirping the whole time. Once I saw a drop of crystal clear Novolog at the tip of the tube’s quick disconnect, I told the pump, that yes, I see drops by arrowing down to “Yes” and pressing ACT. I then had to press ESC to bypass filling the cannula, and then twice more to get the home screen, and then a third time to get to my CGM screen.

If you’re suffering déjà vu just reading this, imagine how I’m feeling at this point. I’ve done this something like fourteen times on four different insulin pumps in the last month.

And as they say on late night TV, but wait, there’s more!

Dateline: 1729 hours (that’s 5:29 pm):
Motor Error.

(((SILENT SCREAM)))

I’m now sitting on the patio of the Chama River Brewery drinking a nice Malbec with some of my university colleagues, thinking—up unitl the alarm—how lucky I was to be spending time with five charming, beautiful, and intelligent women. All of whom are safely and happily married, by the way. Just so you don’t get the wrong idea.

Sick of Motor Errors, and sick of excusing myself from places I want to be, I just unbuttoned my shirt in front of all five of them, disconnected my infusion set, removed the reservoir from the pump—calling it a fucking piece of shit—and rewound the pump. Then I re-inserted the reservoir. Locked it into place. Pressed ACT. Confirmed I was disconnected by arrowing down to “Yes” and pressing ACT again. Then I held the ACT button down to move the plunger forward, the pump chirping the whole time. Once I saw a drop of crystal clear Novolog at the tip of the tube’s quick disconnect, I told the pump, that yes, I see drops by arrowing down to “Yes” and pressing ACT. I then had to press ESC to bypass filling the cannula, and then twice more to get the home screen, and then a third time to get to my CGM screen.

And then I ordered a second glass of wine.

3 Comments:

Blogger Sara said...

In eight years of MM pumping I NEVER had a motor error. I am so confused by what is going on with you!

Dex doesn't technically have predictive alerts but it does have rate of change alerts which I use in the same way. Dropping as fast as you were this morning, the rate of change alerts on the Dex would have caught that too.

8:38 PM  
Blogger Laddie said...

Like Sara, I've been with Medtronic 7 years and never had a motor error. But I may have just jinxed myself by writing this post.

11:01 PM  
Blogger Nina said...

While the Dex doesn't have "predictive low" alarms, it does have rise rate and fall rate alarms. I have mine set to yell at me when ever I'm in down arrow territory (2mg/dL/min) since my worst lows tend to be preceded by some pretty steep slopes rather than gradual drops.

1:19 PM  

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