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!).

Friday, December 19, 2008

Looking for trouble

I was expecting trouble, so I had my eye on the Girl.

A really cool feature of the current incarnation of the Guardian is the ability to leave the screen on all of the time. To do this go Sensor > Sensor Setup > Edit Settings > Graph Timeout > set to None. See how simple Med-T makes their menus?

The device company mid-set of their menus aside (unlike, say, CoZmo or OmniPod who remember that real-live-breathing-human-beings have to live with these devices 24-7-365), this ability to leave the screen on all the time, where I want it, is a really great feature. One that I hope the next-gen pump will have.

As a quick reminder, Guardian is higher up the evolutionary scale than the Para-pump, which shuts off all visuals after a minute or so. Guardian is also better educated and sophisticated. Damn, do I love a smart woman! Guardian has 6 and 12 hour graphs. Poor old Para-pump only has 3 and 24. Guardian has also spent some time at Delphi U, learning to predict the future. Kid you not, the damn predictive alarms are frighteningly accurate. Poor old Para-pump can only tell you the eagle has landed once it has crashed. Yep, it only has threshold alarms.

This is an important technological difference, as CGM systems all suffer from sampling lag. If you are new to CGM, I want to fill you in on why this is. If you are a vet or highly informed person, just bear with me for a minute. Continuous monitoring isn’t continuous at all, any more than movie film is continuous. In movies we are really looking at a series of 35mm slides displayed at a rate of 24 frames per second. In CGM we are really looking at a series of blood sugar readings displayed at a rate of 5-frames per minute for Med-T and DexCom, or 1-frame per minute for the Abbott Navigator.

Not technically continuous, but I challenge you to finger stick 288 times per day, which is what you get with Guardian. But the bottom line is that a lot can happen in five minutes if your blood sugar is changing rapidly. Add to that the second problem: CGM sensors “live” in the water between your cells called interstitial fluid. Not blood. Sugar levels change in the blood first, making interstitial fluid data a hair dated—not unlike the difference between forearm and fingertip testing.

And last but not least, the whole foundation is built on sand in the first place. You calibrate a CGM with a meter….and we all know how far off those little SOBs can be…

So back on track. The point of all of this is that a threshold alarm isn’t a whole lot of help: to have it liberal enough to warn you of trouble brewing you have to set it so high you are plagued by nuisance alarms all the time when you are low-stable. A predictive alarm on the other hand, tracks rate of change and then projects where you are likely to be down the road. It elegantly compensates for the inherent weaknesses built into the CGM universe.

But does it always work. Not 100% of the time. Which is why, when I’m expecting trouble, I keep an eye on the Girl. Which is why I’m so tickled that I don’t have to press any buttons to do just that. I just glance down at my waist and I know more or less where my blood sugar is. I also, at a glance, can see how that relates to where it has been over the last six hours. Like a quick glance at a watch tells you the time without any real brain power being used; a quick glance at Guardian’s face tells me if it is high time, low time, or just the right time—blood sugarwise.

This is what I love about CGM: data with context. Using a meter you might know that you are at…oh, I don’t know… let’s say 108. Good number? Depends. Depends how much insulin you have coursing through your veins and how long it has been around. Depends on if it was 109 ten minutes ago. Or 158.

Numbers are worthless without context.

So back to girl trouble. Oh, no. Wait. This was more woman trouble. To be specific, an elderly lady who I love very much: my Mother. My Mother has moved to town. That’s what caused my most recent nasty hypo.

Well, it wasn’t so much her arrival (stress makes your blood sugar go up). I was helping her get set up. Moving wide easy chairs through narrow doors. Carting 29.34563 tons of books, setting up appallingly heavy Victorian furniture. Basically doing stuff my poor diabetic body just isn’t equipped for. I think you all know I’m not exactly Team Type-1 material. The hypo was predictable, even without predictive alarms. Not only was it predictable; it was inevitable.

Even so, it was a sneaky little bastard. Came on fast and hard toward the end of the day. I had even scarfed down a large burger a about five potatoes worth of French fries as anti-hypo meds. But it didn’t work. They hypo came anyway.

Of course I didn’t feel it coming. I never do. And the Girl didn’t give me an alarm. But I was watching. Watching the “trace,” the life-support-like thin black line on the Guardian’s graph. The heart-beat of my blood sugar.

I had been pretty stable in the 150s. Then the trace shifted. 140s. 130s. 120s. Ut-oh.

Finger stick on a FreeStle Lite (love that strip-port light!) finds me at 70. Crap. Bush-whacked again!

So I’m wearing a loaner Cozmo 1800 at the moment. I dial in the 70 into the Hypo Manager and it spits out my homework: eat 20 carbs (by the way, this turns out to be excellent advice, I had a nice recovery with no rebound hyper). So I drink a bottle of Fox Fluid and eat half a cherry slice. Then I lay down in a box to wait my fifteen minutes.

In a box, I said. Not coffin.

So I’m laying on the floor. Head and torso inside a wardrobe box. Feet and legs on the oriental carpet of the half-empty living room. I’ve got my top half in the top half of the box, because I’ve got all my Rio in the bottom half of the box. He fell in love with the box as soon as he saw it. “Daddy, how do you spell ‘home sweet home?’”


And Rio starts writing this on the box with a magic marker.

You don’t have to have gone to Delphi U to be able to make one prediction: the evolution of Med-T tech. Consider. First came the insulin pump. Then the garage door opener Guardian. Then the Para-pump. Then the new, smart Guardian. So next? Presumably a Smart Pump. One with predicative alarms. Hopefully LOUDER ones. And hopefully ones that both squawk and vibrate. I’ve also got my fingers crossed that I’ll be able to leave the screen on all the time. So I can glace at my dash board without having to press a button.

But somewhere in California, I just know some fool is thinking that we’ll plough through batteries too quickly if we leave the damn screen on all the time. The same batteries that keep the insulin pumping. So to protect us from ourselves, I fear our options will be taken away from us.

But come on, they are AAA. The world’s most common battery. You can get ‘em anywhere. You can carry a spare. Please don’t take my Kodachrome away!

Inside the box, Guardian predicts the low I just treated. Welcome to the party, Girl. Still to be fair, if I hadn’t expected trouble she would have warned me before I passed out.

A few minutes later the Cozmo beeps at me: time to check your blood sugar.

105. Sweet recovery. I’m back in the game, and no worse for wear.

What? There are how many boxes of antique glass?!

Maybe I’ll stay in the box for a while…


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