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!).

Wednesday, January 09, 2013

Pumping with the pump

This will make it sound worse than it is, but taking insulin for a meal with the t:slim requires a minimum of 19 button presses. Don’t freak out on me. Let me walk you through it.

First, it takes four stabs to wake up the pump: You press the only Honest to God button on the pump, and then do the 1-2-3 bull’s-eye target thing to get to the main menu. Then you gotta press the bolus button. Next, you press the carb button, at which point you’re faced with a phone-style number pad—which I love. No more endless scrolling to get to the right number of carbs! You just dial it in. It’s like placing a phone call to your pancreas.

This is a prime example of how touch-technology for an insulin pump really shines. Entering anything with a number—carbs or blood sugar—is faster and more accurate with this pump than on any other pump ever made.

Even better, the phone-style number pad for carbs is really more like a pocket calculator. It lets you add up a meal on the fly. Exhibit B: behold a pair of tacos with classic sides. OK, 13 carbs for the pair of corn tortillas, 2 carbs for the meat and veggies, 12 carbs for the beans, and 15 more for the rice, plus 4 for the sugar-free margarita. Done. The pump does the 13+2+12+15+4 for me, and gets 46 carbs. A running total is displayed at the top as I go along. That’s right, no more writing on napkins!

After dialing in the carbs, one more press of a “done” button takes you back to the screen where you enter both carbs and blood sugar. “Add BG” takes you to another phone-style pad for fixing less-than-perfect blood sugar numbers (this pad doesn’t have a calculator function, as you’d never need to add multiple blood sugars for taking a correction).

Now this was the part I thought I’d hate the most. The Tandem-supplied Verio IQ meter, a fine and highly accurate device we’ll talk about some other day, doesn’t “talk” directly to the pump. So I knew in advance that I’d have to enter the BG manually. Three finger strokes are needed to enter most blood sugar readings, plus a fourth to confirm the entry. But you know what? With the super-fast key pad-style entry of the touch screen, this is not an issue at all. Both Med-T and Animas pumps have meters that directly “talk” to them, but navigating the multiple firewalls of “are you sures” probably takes just as long as just typing the damn blood sugar into the t:slim. Remember, no more archaic scrolling. If you think about it, the word “scroll” comes to us from the days of papyrus and hieroglyphs.

Anyway, the point of entering your blood sugar is so that you can correct it, if it’s not exactly where it belongs, at the same time you’re getting some insulin to cover your chow. Once you enter a BG number, you’ll get an annoyingly helpful popup that telling you your blood sugar is not at target—no shit Sherlock—and would you like a correction? Yes, Mr. Pump. If I didn’t want a correction, why would I be wasting my time and embarrassing myself by telling you my blood sugar?

Oh, and just for fun, I tried to enter a blood sugar of 1,001, but the pump wouldn’t let me get away with that. Nor does it recognize 10 mg/dL. But I did succeed in entering a 20 mg/dL, at which point the pump helpfully advised me to go the fuck out and eat some carbs. And it said it in red text, just to be sure I knew it meant businesses.

But if you were, say, at 65 mg/dL, the pump would reduce the insulin it’s giving you for a meal to compensate. This is called a reverse correction. But one thing I don’t like about the t:slim is that reverse corrections only works below 70 mg/dL. I have no idea why. If I’m at 90 and my target BG is 110, why shouldn’t the pump shave a little off my meal bolus so that I coast in at 110, in a perfect world, four hours later, rather than at 90 again?

Anyway, unless your BG happens to be exactly perfect before a meal (yeah, right) you should take the extra few seconds to enter a blood sugar if you’re above target, so you get little bit more insulin. If you’re below target, don’t waste your time unless you’re below 70.

Now, with the pump safely awakened, your carbs added and entered, your blood sugar on the menu—you’re ready to deliver some insulin, right? Whoa. Not so fast, cowboy.

Most of those button presses are quick, I don’t mind them, and I don’t see any realistic way they could be reduced. But what I do find annoying and tedious, however, are the four “are you sure,” “are you sure you’re sure,” “are you really sure you’re sure,” and “are you absolutely positively really sure you’re sure” screens that stand between the last of my data and the first of my insulin.

This is one of the few things I don’t like about the Tandem t:slim, a plethora of alert, warning, and “are you sure” screens. All pumps have them, and I haven’t added up all the various ones on the market to compare, but the t:slim strikes me as overly safety-conscious. I wish there were a way experienced users could shut some of them off. Anyway, like all pumpers everywhere, I’ve learned to just quickly skip over these without looking at them. Which, now that I think about it, is the whole problem with this sort of Big Brother approach. If you build in too much safety, we dFolks will just ignore it. I think if I had only one final screen, rather than four, I would probably take the time to look at it. But the overabundant safety features encourage me to blindly press the buttons to just get on with it.

When you are finally done with your 19 or more button pushes, you’re rewarded with the splash logo:

Which I think is very cool and beautiful. I just wish it were animated like the testing-blood sugar video on the iBG Star, where a chemical lightning bolt dives through the blood stream dodging red blood cells. If you haven’t seen this graphic masterpiece yet, I’m sure someone has put it on YouTube by now. It’s so cool I used to look forward to testing my blood sugar so I could watch it. It never got old.

The t:slim Splash! is a frozen image, but it’s still a fun way to be told that insulin from your pump is on its way to your body. Thank you kindly, Mr. Pump.

And even with all the button pushing and warning screens, the t:slim is a hell of a lot faster than filling a syringe and taking a shot; and a lot more accurate than dialing up a dose of insulin in a pen.

I’d forgotten how much pumping rocks, and the Tandem t:slim makes it easy. And fun. It’s going to be a great year.

Next week: Inside insulin delivery. Literally.


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