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, April 10, 2009

Random thoughts on the first week

So the gunfight at the DM Corral has started. Bullets are flying everywhere. The blue-grey gun smoke is so heavy I can’t tell who’s still standing, who’s been injured, or if anyone is lying in the dust bleeding to death.

As I write this I’ve had five days of Navigator CGM under, well on, my belt and I’m now cooling my heels for ten hours waiting for the second sensor to fire up. Luckily I have my “first wife” CGM still with me, watching over me, protecting me. Without Guardian on the job I’d be plowing though one hell of a lot of test strips right now.

Guardian is ready to fight in about two hours while Navigator sits useless after a sensor is inserted for at least full ten hours. The official bullshit line from Abbott (Taken from “Healthcare Professionals: Frequently Asked Questions”):

“Abbott Diabetes Care is committed to making its products safe for the user. Soon after the insertion of a sensor, there are physiological processes that happen as the sensor and the body equilibrate. These processes are part of the body’s natural response to a foreign object.” They go on to say the amount of time this takes varies from person to person and time to time. “We have found through our research and studies that it is not always easy to accurately measure glucose in the body when this equilibrations happens.” Abbott’s bottom line, a better safe-than-sorry time period.

Hey, in the first ten hours Guardian isn’t at her best, but at least she is on the job. At least she is giving trend info. She’ll alarm if you start dropping like a stone. I think the two hours it takes Guardian to spool up is too damn long.

Ten hours for the hypo-unaware is a life time.

Or a death.

Both the first time, and last night, I put Navigator sensors on at night. Now real world, if this was my only option, no way would a be putting on a new sensor at this time of day. But I have Guardian to watch over me at night and ensure I wake up. If Navigator were my only CGM I’d hook up in the morning and test like the dickens for the ten hours in the daylight. Better to die awake than die in your sleep, I always say.

You cannot pre-insert your next sensor and let it equilibratize. Pity, that would totally solve the problem; both from our perspective and Abbott’s. You could put one in the day before you need it, hold it in place with a dummy transmitter and when you were ready to rock it would be ready too. The idea probably never even occurred to them.

I guess if you were Bill Gates rich you could buy two Navigator systems and wear them to over-lap by 24 hours. I’m not Bill Gates rich. Sigh. Oh, speaking of money, this is a great time to remind you to buy my book. If you already have please disregard this plug and accept my thanks.

Living with Navigator is like having a tiny little TV screen on your belt, both in terms of size, shape, and quality of its blue-grey light. Of course it only gets one channel; all blood sugar, all the time. I like it. It would have blown the doors off of Garage-door Guardian, which it was built to compete with. But while Navigator languished at FDA, Med-T leapfrogged ahead of Abbott. Navigator is good, but Guardian blows the doors off her in term of features and options.

Both systems do what you need most. Monitor your blood sugar all the time, warn you when the shit hits the fan, and give you tools to better understand and control your diabetes. Either would be better than neither.

To be totally honest, there are things I like better about Navigator and things I like better about Guardian. If I could throw them in a blender and turn them into one device I probably love it. If I could add the Cozmo to the mix (Taps playing in background) I’d be in heaven.

Navigator insertion is easier, but the whole design of the plastic frame for holding the transmitter is awful. It takes up a lot of skin. Guardian, even though the sensor probe is larger, takes up a quarter of the space on your body that Navigator will.

Navigator is LOUD. I like that. I wish she had personality like the Old Guardian did. (Note: modern Guardian uses a “bee, Bee, BEE” tone for high alarms and a “BEE, Bee, bee” tone for lows; each an octave up or down from the previous, but they are so short and low in volume as to hardly be noticeable. I use the vibe alarm instead.)

Test strips. Boo-hisssss to Abbott for locking the door so that you can only use their strips. I’m sure someone in marketing thought this was brilliant, but I causes barriers. Anyone on Fucking Presbyterian will have a hell of a more difficult time getting covered for Navigator. Which is actually ironic, as Pres has been one of the better insurance companies to have if you need CGM. They have been pretty good about accepting it as a benefit, especially for the hypo unaware (just God help you if you need a name brand drug or a pump). But Pres, at least in my neck of the woods, will only pay for Accu-chek strips. Period. And what if strips get lost?? What if meter craps out??? Abbott was being greedy. They could easily have had both the built-in meter and a way to enter a stick from any meter just like insulin pumps. Hmmmmmm….maybe Abbott is wearing the black hat.

And speaking of black hats, who ever designed the alarms for Navigator is not diabetic. The alarm designer for Guardian probably is. Navigator alarms every fucking fifteen minutes as long as an alarm condition exits. I guess the Abbott team has nooooooooo idea how long it can take to turn a stubborn high around. Even with a heavy bolus, three hours or more might pass. The only solution Navigator offers is a one hour muting of ALL alarms. That would include your low alarm to. Great. Just fricken great. And, to add insult to injury, there is no way to un-mute the muted alarms. Once you choose that option you can’t un-do it. Navigator will be silent for one hour.

Guardian on the other hand, lets you independently set a variable “snooze alarm” for both highs and lows. For instance, I set my high snooze at three hours. If I go high then it tells me and I take a correction bolus. But that high sugar is not going to go down right away. Why be pestered by more alarms? If I keep throwing insulin at the problem too often I risk “stacking,” which leads to low alarms. Lows on the other hand spook me. I let the Girl tell me every 20 minutes if I’m still low.

So we rode in to town on the stage coach this week. Me, Cozmo, Presto, the new kid, and Guardian riding shot gun. What are the odds that the whole crowd could agree on anything?

Well, it may surprise you, but every once and a while the two CGMs read exactly the same. When I was a kid we went on a family vacation “back East.” Amongst other places we went to Gettysburg. I remember seeing a beautiful metal flower at a museum. It was created when two bullets hit each other head on. What are the odds? Well I guess if you have an infinite number of monkeys on an infinite number of word processors one will write Shakespeare by randomly typing, right?

Next time: arrow to the heart


Blogger Crystal said...

Yet another great post.
I Did buy your book. Let my dad read it and He bought a book! ;-)
Hoping the same happens with my mom.

All of this information is sincerely honest and To The Point.
And yeah, marketing at these manufacturers....wouldn't a "walk-through" be a wake up call for all parties involved. They've no clue except for Their Bottom Line. Bastards.

Thanks again for another great post.

11:04 AM  
Blogger Scott K. Johnson said...

You've got some very good points here Wil! I'm really enjoying the comparison so far.

6:58 PM  

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