Tag: Continuous Glucose Monitor (CGM)

To Pump or Not to Pump

To Pump or Not to Pump

Pump and CGM

I don’t meet, in person, very many people living with Type 1 diabetes. In fact, there is only one other that I see regularly. There are others in the area. You just have to participate more. On the rare occurrence that I do, it seems that many of us suffered the same dilemma.  Should I get the pump?  Should I get a CGM? Is there enough room on your toothpick-shaped body to have two devices?

Apparently, many of us ask these same questions.  I was very resistant for years. I always thought that I would need better control of my diabetes before I thought about adding expensive devices to the equation. I was worried about not being able to swim or shower because I was always plugged in. He was worried that he didn’t enough fat on his body to accommodate two devices. I now use both a pump and a CGM and wear them 24/7. They have dramatically changed my life with diabetes. I have much better control of my blood sugar. No where near as good as mine was. And I don’t resist eating because I don’t feel like taking a shot or dealing with my disease.  I no longer have the strange lows or highs that I cannot explain my basal insulin isn’t adjusted just right.

My endocrinologist, who I think is excellent, did not seem keen on me getting a pump.  He didn’t tell me not or that I shouldn’t; it just appeared that it wasn’t something he felt I needed. He did seem very keen on the CGM though. Probably because your A1C was consistently pushing 10. A few years ago, I found Keri Sparling’s blog, Six Until Me, and felt that I had found a kindred spirit of sorts.  I had found someone else that knew exactly what life with diabetes was like.  She had just had her baby and my wife had recently delivered Squishy as well.  As I have never had a c-section or attempted breast-feeding, I could not relate to everything  in her blog, but many things that were affecting her were also affecting me. The one thing in my life, that seemed to be missing from hers, was the annoying need to constantly stab myself with a needle. The hard bumps that kept forming in my abdomen and hips because I could not find new places with enough fat to give myself another injection. The irritation of accidentally leaving my insulin at home or not bring enough with me for the day. Not that those situations do not affect a person using the pump, but those were affecting me constantly.

I finally got my CGM in February 2012. It only took a moment for me to see the benefits of it. My A1C immediately started dropping. Just having an alarm to tell me when I was in trouble or being able to see what my eating habits were doing to my blood sugar took my A1C from a 9.1 to 6.7 in a few months. No, my blood sugar is not perfect and I still have my ups and downs, but I would not go back to the way things were. In fact, my endocrinologist asked me at my last visit, which device do I think contributed the most to my improved A1C. I told him flat-out, the CGM. The pump is nice and I wouldn’t give it up either, but the CGM is the reason my A1C is better.

But, if you have been keeping up, I have a pump as well. Which must mean there is something I like about it. I don’t know about every pump, I know about my pump.  So if you are thinking about pumping insulin into your body, some research into what the different pumps offer and what the pros and cons of each are is an important step. One he skipped. I chose the OneTouch Ping from Animas. And it is true, I did not do my research.  What I saw was something from my favorite diabetes blogger talking about her Ping and being able to swim without worrying.  I cannot find it now, or I would have linked to it. Mostly because he can’t remember if it was a video, a blog post, or advertisement on the Animas website. I love playing in the water.  My girls love playing in the water. We always live near a pool because they love the water. So I needed the one that allowed Kerri to go in the ocean without worrying. Don’t get me wrong; I love my Ping. And for those of you with the same list of concerns that I had, here are the responses I wish someone would have given me, as they apply to me and my Ping:

I will have to keep a close eye on the clock when playing in the water because I won’t be able to take my pump with me.

Not true. Many of the pumps are waterproof.  I spend hours in the water with the girls and don’t even think about my diabetes unless I feel light-headed or start to smell that funny your-blood-sugar-is-outrageously-high smell.

I won’t be able to take long showers any more.

So, as it turns out, the pump isn’t constantly delivering insulin to your body.  You tell it when you eat to give your bolus just like you would do with your regulated stabbings.  The difference is, no stabbing. What it does do, is give you a little bit every hour to keep your regulated when you are not eating.  And if you are taking a long shower and miss that one basal, which for me is 0.625 units of insulin, who cares.  Seriously, it isn’t a big deal. I don’t even think my body notices if it only misses one.

I’m too skinny. I’ll have nowhere to put it.

You actually have more options than you think. Areas that are difficult to reach are now options because you only have to reach it once. The love handles work great for me. Love handles? Those are not nearly big enough to be handles.

How will I have naked fun when I must have something to clip the pump onto?

This is exactly the same response as the one for the shower. Which could also be naked fun. In fact, this may even be better.  You are replacing the small amount of insulin you are missing with physical exercise.

Don’t be afraid of the devices. They are awesome and have made a world of difference in my life.  If you really cannot get around your fears, start with the CGM. Once you realize how awesome it is, you will be rushing to get plugged into a pump.

Day 3 with Dex

Day 3 with Dex

My Dexcom Continuous Glucose Monitor (CGM) arrived on Friday. I plugged it in for 3 hours of charging and immediately started getting myself connected. He was like a kid in a candy store. Metaphorically speaking; of course. It has only been 3 days, and I have already learned a great deal from the little egg shaped device. What I thought my blood sugar was doing goes about like this:

  1. I take my basal (Lantus) insulin at night keeping me steady for most of the night and my blood sugar would start dropping just before 5:30 AM (when I normally eat breakfast). Except on the weekends when he would wake up at 9 with a BG of 50.
  2. At 5:30 AM, I would take my bolus (Novalog) insulin for breakfast and eat some cereal with milk. Some? His cereal bowl is the one normal people use to mix cakes with.
  3. Around 11:30 AM, I would start to feel a little low and then I would test and I would be some where between 60 and 80. I would bolus and eat lunch. Usually, he skips step 3 all together.
  4. Around 6PM I would make dinner for myself and the kids, bolus (which I always seems to under estimate the bolus needed) and spend the rest of the night bolusing until bed time trying to figure out why my estimate was so badly off.

That is what I thought was happening. Dexcom shed a little light on the situation. Any more light and his nose hairs would catch fire.

  1. I take my basal insulin at night and then steadily drop until around 5:30AM. The trend looks a lot like a slide.
  2. At 5:30 AM, I take my bolus insulin for breakfast and east some cereal with milk. Then, I spike to about 350.
  3. I slowly, but steadily, fall back down to between 60 and 80 at around 11:30 AM. I bolus and eat lunch. Then, I spike to 300 or better and about a half hour later drop to around 120.
  4. Slowly go down to about 112 and then at 6PM I make dinner for myself an the kids.  I bolus (which I still seem to under estimate) and spend the rest of the night steadily climbing higher and higher while bolusing to try to get back off the escalator.

CGM reading 255

What is that all about? Poor diabetes control? Talk about total shock. I had no idea my blood sugar was bouncing like that. He should really test more. I look at the two lines on the Dexcom my blood sugar is doing everything it can to stay out of them. And what is my basal doing? Drawing; like on an Etch A Sketch. When I am sleeping, my blood sugar is dropping like a rock and after dinner, my blood sugar just holds steady at 250. Tonight, I had two tuna fish sandwiches and some pork and beans. I would guess about 110 grams of carbohydrates. That is roughly 7 units of insulin for me. That was my bolus at 6:30.  After eating dinner, Dex started freaking out and my trend was raising to the top of the meter. I have been taking 3 units of Novalog every half since and my trend is almost a straight line. Not going up; not going down. At least he has some consistency. Just piling on the Novalog and the line isn’t budging. But I’ll bet if I take my basal dosage, I will be heading back down again. Its like before lunch my basal is trying to help me remember what hypoglycemia feels like and after dinner we are reminiscing about hyperglycemia. Have some ice cream. I’ll bet that will get that line moving. Thoughts? Anyone? PICK ME! PICK ME! Anyone else?