Category Archives: Diabetes

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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Walking to Stars Hollow

Well, in a sense, anyway…

I’ve known for a while that I needed to get back to walking for some time now, I’ve just been making up excuse after excuse as to why I couldn’t:

  • the treadmill was cluttered
  • I’m too tired, I’ve worked/cleaned/chased kids all day
  • yada-yada-1432923_640

    Photo credit: Pixabay – geralt

    I don’t want to deal with basal rates right now

  • I’m doing too well with my glucose control and exercise right now would just screw it up
  • I’m too busy with the kids, work, blahhhh blaahhh..
  • Exercise helps the most in the morning, and I’m too tired in the morning since the toddler still won’t sleep through the night.
  • I don’t need to, I walk enough keeping up with the toddler now since she walks everywhere and gets into everything

On and on and on. Seriously. And on…

But I finally just took a deep breath and made myself realize that:

  • my diabetes will always be here (hello, no cure yet… still waiting,) so therefore, the challenges around balancing insulin requirements will always be here,
  • Photo credit: Pixabay - Clker-Free-Vector-Images

    Photo credit: Pixabay – Clker-Free-Vector-Images

    exercise is a weird thing in that if you don’t have energy, exercise will help give you energy. Unless there’s some other underlying cause like hypothyroidism (which I have, and also just had medication adjusted for this week) as well as things like anemia (which I have had, and it is a tired feeling beyond belief.)

  • exercise, while it is helpful for your day if you can do it in the morning and you do burn more calories, does not have to be in the morning. Fit it in whenever you can, just do it.
  • I have two kids… they need to see me exercising to take care of my body so that they know it’s a very important part of staying healthy, even if it’s just for 20-30 minutes a day.

I love watching Gilmore Girls. I’m a total geek. I’ve watched it through THREE times since it’s been on Netflix. It’s one of those shows that just draws you in, and you wonder what it would be like to live in a dreamy town like that. I get lost in the episode and time is up before I realize it. I love watching the show, and I know that each episode runs at least 40 minutes.

1Wb7vCqPiZPOjBcB.jpgMy solution? Rather than spend that 40 minutes doing nothing, I’m going to walk and watch. People walk to music, I walk to Gilmore Girls episodes. For those 40 minutes, I walk step by step to a little imaginary town of Stars Hollow so that being on the treadmill isn’t so boring.

40 minutes on a treadmill will be just over 2 miles if you walk at a 3 mph pace. My goal? 35/3.5/3.5 (because I like ratios.) 35 minutes at 3.5 mph, at a 3.5 percent incline. This gives 5 minutes left over, to be split between beginning and end for warm up and cool down, which is important for your heart and muscles; and I still get my 2 miles in.

After I’m comfortable with that, I plan on upping to 40/4/4, and just doing my warm up/cool down outside of watching the show. I’ve actually been going over my time limit a bit in efforts to knock down some highs by walking.

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One of my “good” days

I’ve actually been going over my time limit a bit in efforts to knock down some highs by walking. Not that taking insulin for a high is bad (it’s NOT,) but if a simple 10-minute burst of walking can help curb the spike, I’m all for it.

Now, I’m on a mission. I know how much I want to exercise. Now, I just have to fit it in with life with diabetes, which can be hard. Meltdowns from frustration due to lows and timing have happened and probably will happen again. But I’m not going to let it stop me.

I can do this and I will do this.

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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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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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Glooko, t:slim, and Dexcom = My Dream d-Data System

I remember using Glooko way back when I had the old iPhone 4s cable (I actually found it in one of my supply boxes yesterday) that connected to my freestyle meter. I honestly don’t know how long I’ve had that account, but I’m glad that I do.

glookoWhen I first had my t:slim, Glooko and mySugr were the two apps I kept my data in before t:connect was approved by the FDA. In a way, I hated it because I *had* to manually log everything. But, in a way, it was good because I had to pay attention to everything. I think that was the only time I had the lowest A1c ever because I had to think about it and manually log, so I kept everything in check regularly. But, I always liked their reports, and the app interface.

Now, Glooko has come a long way from how it looked back then. There is so much more to the app, and we can connect more things. I like that I can upload my Bayer Contour Next meter into the system with my Nexus tablet, and that I can set Glooko to pull my Dexcom data from the Dexcom “cloud” via my Apple Healthkit. They are also making strides to also include pumps into the upload process. Just recently, they were able to add the Omnipod and they’re working on a way to add the Medtronic pumps into the lineup.

I have gone back to logging and have downloaded my own reports just to see how they compare to other sites such as the t:connect and Diasend online apps. Honestly, I have to say, I like the Glooko app’s reports SO much better. They are simple yet comprehensive. They are easy to glance over or delve into – however you need them, they have it; they are the perfect combination.

With t:connect, you’re limited on the meters you’re allowed to upload with, and if you don’t use the t:slim G4, you can’t upload your Dexcom into the system – which I think is absolutely crazy. I like their reports too, but without Dexcom in it, I feel like I’m not getting the whole picture. I might would consider changing meters otherwise if they did, but they don’t, and I don’t think they will.

While I like Diasend (I don’t *love* it) because I can practically use any meter I want to use (a.k.a., my beloved Bayer Contour Next USB). Currently, Diasend does not pull data from Dexcom if you have the G5 – neither from the receiver itself nor the Dexcom Cloud if you are in the US, which I am. So since upgrading to the G5 system, I no longer have access to full-data reports, and I’m back at being as frustrated as ever.

Glooko App and tslimAfter seeing the Glooko¬†reports, I really¬†want Glooko to be my go-to web service for all of my diabetes devices. The reports are easy to read and understand, and don’t look like they are from 1990. Since I can’t manually log my basal rates and temp basals and things like that (they say it’s so that records stay consistent, yet I can manually log boluses…. which if I don’t, that would be an inconsistent record as well… so I don’t really follow that logic), I only get 3/4 of the picture. I want my t:slim to be able to upload so that I can get the full report. The reports look to be really comprehensive but I can’t take advantage of it until I can upload my pump.

So, with that being said, I’ve talked with people from Glooko and they are willing to work with Tandem if Tandem is willing to work with them. And, of course, this is something we have to bring up to the companies. Sometimes they will work on things a little faster if their customer base raises their voice and gives them a nudge.

When I called Tandem earlier this week, someone else had already called and put in a request too, so it’s something that not only I am wanting as well. If you don’t want to call them, that’s ok. There is a web form as well that you can fill out and request it – easy peasy.

So, ladies and gentlemen… can I ask a favor? If you use a t:slim, can you go online to Tandem’s contact¬†form (or call and personally request it if you happen to have to call them anyway) and request that Tandem work with Glooko? Pleeeaase??? With a cherry on top?? Thanks!!

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