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Our Decision to Switch to Medtronic Minimed 630G Insulin Pump – Part 2

This part may be a bit long, so go get some coffee and settle in. There is a lot to cover here ūüôā

Ahhhh….coffeeeeeee…. (Pixabay)

I started on the Medtronic 630G pump on 5/1/17 – the day I received it. This is a bonus of having a small endo office – they can pretty much work you in at any time for device training.

So, in the boxes were the pump box, sensor box, and meter box. Along with lots of papers and training books. I had also already watched the training videos and played with a demo too, so I had a general idea of what to expect.

Using the pump wasn’t my concern at all since it worked pretty similar to other pumps — it delivers insulin based on your settings. Okay, no biggie. The biggie for me was whether I could trust the CGM or not. This is a big question for many, especially if you are die-hard dedicated Dexcom user as well.

See, I had the 530G before with Enlite. I did not have good success at all. It was rarely correct, and I was going through sensors every 3 or so days. It wasn’t worth the hassle it was giving me. But, I had been keeping my eye on the 630G since it was available, and I wanted to see what other’s were experiencing. The consensus was that the 630G was much better somehow. I believe they updated the algorithm a bit, and it was supposed to be a vast improvement.

The game-changer that helped the transition:

I made the decision that others had (CarolCluka and CoolReeRee ) to keep my Dexcom sensor attached until I was fully comfortable. This lasted about 3 weeks. I kept my Dexcom connected to my Glooko account because I can connect Glooko to Medtronic Carelink, and I could see how they both compared. I was pleasantly surprised, to say the least:

Of course, there are times when the sensors didn’t line up perfectly, but as you can see, they’re pretty on-point with each other.

I’ve had pretty good success, and so much that I disconnected from my Dexcom after 3 weeks and felt completely comfortable doing so.

The good, the bad, and the tips…

Now, let me tell you… it hasn’t been all cupcakes and rainbows for the last almost-two-months. I did go through about a week or so of wildly inaccurate¬†readings. So much that I reconnected my Dexcom. See, the problem is that you cannot jump into the Medtronic system with the experience of Dexcom. You have to wipe that mindset out and start over.

First and foremost, you have to calibrate at least twice a day, but it is recommended to be 3 times at a minimum, and 4 max. So, I’ve developed a routine – I calibrate when I wake up, again before lunch, and before bed. The system stays pretty accurate if I do that, which is no problem really, because it’s not hard to do. I’ve never been one to feel comfortable enough to dose off of my Dexcom, so I always test before eating. All it takes is a click to calibrate, and then a click to go to the bolus wizard. No big deal at all.

Second, there are rules:¬†(I’m sure they could apply to Dexcom too to help make it be more accurate, but these are sort of a must-follow in my opinion if you are on Medtronic’s system)

  1. Follow the “B” rule when learning your own calibration schedule: Before breakfast, before lunch, before supper, before bed. Find three of those that fit YOUR schedule and when you know you’ll be least likely to be trending wildly (aka – no arrows)
  2. Do NOT calibrate if you have bolused in the last 2 hours. The sensor is less likely to be as accurate since you have bolused in that time, and a calibration could confuse the sensor.
  3. If the sensor is “off”, especially when waking up first thing in the morning, try drinking some water and walk around a bit. This gets the interstitial fluid moving around the sensor again. It will likely re-align itself within 30 minutes or so.
  4. Be patient. I cannot stress this enough. If coming from Dexcom, you may be used to the instantaneous calibrations.¬†The sensor can take 10-15 minutes to accept a calibration, especially if the values are very different (up to 60mg/dL). If it is above 60mg/dL, try the drinking and walking bit. If it doesn’t realign, call tech support for help or a new sensor. They can help you upload your pump and look for specific things that could be interfering with the sensor communication.
  5. When inserting the sensor and taping, BE GENTLE! Taping the sensor head down too hard or pulling the transmitter tape flap too hard and tight on top of the transmitter can cause the sensor to pull out just a bit from the skin, which can cause big trouble. If you set it up softly, it will be nice to you.

After I called tech support, I found that I was being too rough with taping, and not being patient with the calibrations. Since then, I’ve been able to go back to Enlight sensor values only, and it’s been just as good as it was when I first started. Heck, it’s even caught real, legit lows that the Dexcom didn’t.

In the past couple of months, I have been greatly impressed with the CGM of the Medtronic 630G pump. I’ve caught myself at times in awe of it, really.

Why the 630G now and not wait for the 670G?

One question I was asked already on Facebook was “why not wait until the 670G?” The reason is that I wasn’t sure I could trust the sensor to make the call to give me insulin if I were going above range. Cutting off my basal for a couple of hours is one thing — giving me insulin when I don’t need it is a whole other realm, and I wanted to be sure I could trust the system. I am on the list for the 670G, and I should be able to get it next month once my sensor order is due (that’s how they time when you get it if you’re on the pathway program).

I am on the list for the 670G, and I should be able to get it next month once my sensor order is due (that’s how they time when you get it if you’re on the pathway program). I can use the pump similar to how the 630G works now when I get it, and then wait to be trained on “auto-mode” later. I am cautiously excited to see how it works, but I’m also not going to be entirely upset if it doesn’t live up to the hype I’ve seen. Mostly, because I know the experience is going to be different for everyone, and I know it can be a learning curve even if you’re coming over from the 630G.

And, to be completely honest, it would be the same hesitancy whether it was the Medtronic system or one that incorporated Dexcom. Anything that augments how my insulin is delivered, I’m going to be very hesitant about. I guess I’m just old-fashioned and have been burned by eagerness one too many times.

Where to view more if you’re interested:

I’ve been trying to keep this to myself and a few close friends in the beginning just in case this new experience caused me to be upset and disappointed. I prepared myself for the worst, thinking it would be no different than the 530G. Maybe that’s why I’m so much more surprised than I thought I would be.

So, instead of blowing up their phones with text or Facebook messages, I decided to revive my Sugar and Sites domain for Instagram and Tumblr, and get my thoughts out there.

You can click on the image and it will take you to the Instagram page I’ve been using. Let me know in the comments what you think, and if you have any other questions. From those, I’ll make a Part 3.

Which brings me to my next thought: I may begin transitioning from Sugabetic to Sugar and Sites overtime. I’ll still keep Sugabetic alive, but maybe on a free WordPress site. I’ll handle the transition as smoothly as possible, but there may be a few days that things will be down. Until then, feel free to follow me on IG for updates about the pump experience ūüôā¬†

 

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Our Decision to Switch to Medtronic Minimed 630G Insulin Pump – Part 1

A few months ago, I was at home with the kids, and didn’t feel quite right. After a quick fingerstick, I saw that I was in the 20’s. In a panic, I couldn’t get anyone on the phone to talk with me until my sugars came up. I began to “eat the kitchen”, as it were. I finally reached my sister-in-law, who came to sit with the kids until I could get back to myself again.

After that day, I was scared out of my mind to go below 100 if I was at home with the kids by myself. So, I started running my numbers higher — much higher than I’m comfortable with, and I knew I would be risking damage doing so.

That’s when I realized, Dexcom Share wasn’t enough. It’s great to be able to Share and have people call to check on you… but what if they can’t actually reach you? My son and daughter can’t use my iPhone just yet (he can’t remember my unlock code), and neither¬†know how to use a glucagon kit.

I looked into the Loop system, but honestly, while I love that everyone is so willing to jump on board, I’m not.¬†I’m not confident in my own abilities to make this thing happen since it’s something done from home. I don’t mind tinkering and playing with Nightscout because it’s not directly affecting my insulin dosing, whereas the Loop system does. That’s a-okay if you’re on it – I’m not trying to down the system or anything. I’m just not comfortable with the idea of using it myself.

So, we looked into Medtronic. I know. It’s known as the big evil empire of the insulin pump world. And, while I am interested in the 670G, I was more interested it the 630G since it suspends insulin if the user is low. I know this is the exact same technology as 530G, but somewhere along the way, they’ve improved the CGM technology. I kept reading about how sucky the 530G was but that the 630G was much better on different sites, like Instagram and TuDiabetes, and a few others. People who had absolutely zero success on the 530G were being impressed and excited about the 630G.

After a lot of debate and hemming and hawing about it, I decided to take the plunge. I was going to trade in my Tandem using the Switch-to-System program, but I couldn’t afford the $1249 out of pocket to do the switch. So, on a whim and a prayer, we submitted for insurance coverage. Backed with letters from myself and my doctor, along with pages of blood sugars showing the amount and severity of the lows I had been having, we held our breath and waited.

On the evening of 4/28/2017 just after 5pm, we got the approval from my insurance. And, on 5/1/2017, I began as a Medtronic pumper again.

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Hey, look, I’m Alive!

Holy moly, it’s been a terribly long time since I blogged.

I’ve been so caught up with everything going on that I seem to have neglected things over here. I swear it’s not on purpose though. ¬†I didn’t realize how much harder it would be to maintain a blog after having a second kid… especially when that kid is very active and into everything.

I haven’t not been writing, though. I’ve just been writing more for my work at Diabetes Daily than here.

And, being a work from home mommy (working for mySugr as one of their awesome “Support Angels”), I don’t want to use a computer for more time than work is needed. It’s all about finding that balance of work and play while keeping up with a very active, rambunctious almost 2-year-old¬†and almost 6-year-old!

Also, it’s been sort of a “meh, what’s new, what have I *not* written about” sort of attitude¬†too towards diabetes. I’m still the same as I was – almost 29 years into this condition, no cure yet, and I’m done with having kids soooo¬†anything I would post would probably be sort of boring.

My obsession lately has been watching the market with pumps. I have to say, after Tandem’s stock plummetted in November/December, I really worried about them — and still do as they haven’t been able to recover just yet. But, as they said in their earnings call yesterday, it’s typical to have a slump in the beginning of the year due to deductibles resetting. Plus, Medtronic just started shipping their 630G platform pumps at the end of last year as well, so that also could have had an effect on all pump companies, not just Tandem.

I have several opinions, but I won’t go into detail because it would only be spreading what I *think* *might* could happen… and that’s a BIG might. Let’s just say that I hope their move of moving to smaller facilities, possible launches of G5 integration and the new t:lock sets/cartridges, and end of year/beginning of 2018 aim for Low-Glucose Suspend functionality is enough to keep them going. OH, and the hope that Medtronic’s delayed availability of the 670G pump will buy them more time too.

Otherwise, I’m just pumpin’ along. I’ve been using the Omnipod from a PDM and pods that friends have gifted me while I take a tubing break again. I loved being on MDI at the end of last year for the freedom, and I missed that during the winter. Plus, my daughter thinks it’s fun to pull my sites out. NOPE. My only trouble is that I tend to forget the PDM a lot… like…. a LOT. And I miss taking micro-doses when I see my BG is rising.

So you can imagine my BG has been all over the place, but I’m hoping it will make me learn more diligence in my testing/bolusing¬†routine as well. Rather than just being quick-draw-McGraw and reaching for that quick-bolus button throughout the day.

So, yes, I’m alive. I’m here, working and baby-watching away, while trying to keep my sanity with diabetes.

 

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Pump to MDI: Pleasantly Surprised

I know I haven’t written in quite a while, and mostly because¬†I haven’t had time. I’ve had plenty to say, though, trust me. So I’ll try to spare you and give you the Cliff’s Notes version of what’s been going on the last two months since starting on MDI (multiple daily injections).

IMG_4204When I came home from the beach that day, I had no idea how long I would actually take a pump break for. Usually, it would only be for the weekend… if that long. I always felt much safer using an insulin pump for reasons like temp basals and such.

But in addition to feeling safer, I felt unashamed. It’s crazy — me, the advocate for those who prefer MDI and wish to inject anywhere they want to — was suddenly the one who felt too self-conscious to dose in public. With an insulin pump, I didn’t care. No matter where it was stashed, I would pull, shake, or shimmy that bad boy out and bolus without batting an eye to see who may be staring. Now? I find myself injecting in the car before going into a restaurant… or ducking into the bathroom. ¬†In my mind, others are staring at me and judging me for taking my shot in public. I’m slowly getting out of this mindset though, and trying to move past it.

But, I’ve loved being tube-free. I went back on my pump last weekend because we were going to have pizza, which is something I have no idea how to dose for on MDI, and I wanted to be able to extend my bolus like I’ve always done. And, not wanting to waste the insulin, I stayed on the pump for 2 days before taking it off again. During which time, I constantly fumbled with where to put it and I almost ripped my site out practically every time I went to the restroom. It’s crazy how quickly I adjusted to being without an insulin pump. The freedom feels amazing.

My numbers aren’t worse on MDI as I expected either, but quite the contrary. My averages are roughly 10-15mg/dL lower than what they are on my insulin pump, to which I have been pleasantly surprised. I have no idea why there is a difference, but part of me wonders if actually injecting the insulin is better for my skin and metabolism verses an infusion.

IMG_4148Of course, it could be because of the awesomeness of the basal insulin that I’ve been using, Tresiba. I honestly love it. Out of all of the ones I’ve tried (Levemir, Toujeo, and Tresiba), it’s been the most steady, and as long as I bolus correctly for meals, my BG is not nearly as “swingy” as it is with other basal insulins. I don’t notice any peaks, and I can take it every 24 hours without worrying about it running out in my system.

Now, my pump warranty is up in 5 months. I’ve been on the fence about what to do — to get a new pump or simply keep going with MDI and use my current pump as a backup or if I wanted to switch over for a break or anything. Then comes the question of¬†which pump to go with… to stay with Tandem, or go back to Animas or Minimed, or go with Accu-chek since I love their Expert and Connect system. I mean, it’s a big decision. It’s one that I have to be confident that I’ll be happy I’ve made as I’ll have that pump for another 4 years.

Either way… I’m happy and comfortable currently with my MDI treatment. It’s going well, and for the first time, I don’t feel the urgency to run and put my pump back on. It’s almost like… freedom.

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Bolus Advice: MDI With Less Math

A couple of weeks ago, my husband and I went to the beach for the day after church. It was a nice, cool, breezy day and it was good to get away and relax for a bit.

We were on our way home, and we stopped to get a frozen yogurt treat with the kids. I bolused with my pump, and half way through, I received an occlusion. The second one for that weekend.

True, this may not be a big deal, but it was the final straw for me. It’s true — occlusions are things that come with the territory when using an insulin pump, and that specific event isn’t what had me frustrated. It was a lot of things: ¬†having a curious baby who likes to pull on my tubing, sites that were seeming to fail after just 2 days, and the more and more frequent “bleeder” sites.

That last occlusion was it. We made it home and I pulled out my Levemir backup pen that my endocrinologist always gives me to keep on hand in the case of pump failure. I had no idea how this was going to go, but my frustration outweighed my fear of the unknown-to-me territory of MDI (multiple daily injections).


I took my total basal amount, added 20%, took the injection, and unhooked my pump. It’s been in my desk drawer ever since.

As soon as I injected the Levemir and started to get ready to inject for supper, I felt overwhelmed by things like accurately calculating doses and keeping up with IOB (insulin on board), and I quickly emailed my Accu-Chek rep and pleaded with her to chat with me that night or the next day to set up my Connect App in my phone.

Why would I need her?

See, Accu-Chek now has a meter, the Accu-Chek Connect, that connects to your phone via Bluetooth, and you can see your readings, log food and insulin doses, and even program the app to text your readings to a family member if you need help.


It also has an option for Bolus Advice. With this enabled (via prescription from your health care professional), you can use the glucose number that is sent to your phone to calculate insulin doses if you are a MDI user. To me, this is great because it’s like having the best part of the pump without the pump!


The app even lets you see how the calculation works, and whether you need to increase for correction, decrease for active insulin, or if you’re low — how much food to eat. It’s really intuitive.


I honestly don’t know that I would still be on MDI if it weren’t for this app. I’m loving being pump-free without having to be bogged down with math.

I don’t know how much longer I’ll be on MDI, but I don’t feel as if I need to rush. I feel comfortable to be pump free as long as I have help calculating my doses and keeping up with active insulin — which is exactly what this system does.

While the meter was provided to me at no charge, I was not asked to review it. This is my honest opinion from the bottom of my heart. I cannot be more thankful that there is a company that not only wants to create an insulin pump product, but also to help those on MDI to have the best care possible.

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Why a CGM is Important to Me

I didn’t know I was low.

I was sleeping peacefully.

My Dexcom started alarming that I was low, but somehow in my brain I just knew it was wrong. I had no symptoms. No rapid heartbeat. No sweat. No confusion. No anything.

If I hadn’t had the Dexcom, I don’t know if I would have woken up.

I am a firm believer that a CGM system should be standard of care with any diabetic taking insulin. When I had tighter control, I had hypoglycemia unawareness, but now that I’m a bit more relaxed, I’m usually able to catch the lows in the 60’s. But not this time.

All it takes is one time.

One time to not feel it.

One time to not have symptoms.

One time to not wake up. 

I’m ok now, just dealing with the aftermath with a low-induced headache and feeling overall draggy today (both from the low and my daughter who is my little night owl / early bird). But times like this? Rock me to my core. It’s times like this that make me wonder and think of how insurance companies can deny, any diabetic on insulin who has been prescribed this device, access to it. It shouldn’t be their call. Something needs to be done.

CGMs shouldn’t be considered a luxury item – they should be as standard as a glucose meter itself.

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And The PumpPeelz Giftcard Winners Are…

Hey everyone!! I’m sorry I didn’t get a chance to post the winners of the PumpPeelz giftcard Giveaway yesterday. Things got a little hectic around here and I didn’t get a chance.

Today, I used a random number generator online to choose 3 winners, and here they are:

Screen Shot 2016-02-24 at 4.44.33 PM

PP Giveaway Winners

Congratulations to Isela, Erika, and Megan!!! You guys will be getting an email from PumpPeelz with your gift card code.

 

Thank you to everyone who entered!!!

 

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