Saturday, December 23, 2006

Day Nine & 10: CGM Trial

Howdy Folks!

So my travel day was interesting Wednesday. I removed the transmitter and sensor at 5:45 a.m., got to the airport and waited for my flight. It was delayed, but I got on the plane and waited for another half-hour. The flight eventually was delayed so long that I would have missed the very event I was planning, so we were forced to call the whole thing off. I got off the plane and came home.

When I got home I put a new sensor and transmitter on my right arm. It was fairly easy, although I still struggled a little getting the transmitter snapped into the sensor mount. At about 8:00 p.m., I was digging in the closet for wrapping paper and bumped my arm. Sure enough the whole darned unit popped off. Pretty frustrating as I was one hour from calibration. I had just walked the dog and was a tiny bit sweaty, but no excuse. The adhesive should hold better.

I put a new sensor on my stomach and immediately put on over-adhesive (Tegaderm) and was alerted at 6:30 a.m. to calibrate the navigator with a finger test. I now know the best time to put the thing on is 10 hours before you want to get up in the morning.

I have to say, I am not as thrilled with either this insertion, or the adhesive issues. I peeled off the Tegaderm and re-applied it because it felt like I put it on too tight and it was making the unit edges dig into my skin. Yesterday, it just felt uncomfortable, so I took off the adhesive very carefully avoiding pulling the whole thing out and put on the other brand of adhesive they gave me (forgot, will look later). It feels better today, but I am hoping to try the arm again (WITH an adhesive over it )at the end of this session.

Regarding comparisons with my meter, I have checked four or five times and the results are between two and 10 points different. Works for me!

I got a question about water protection on a previous post and the sensor and transmitter are waterproof up to a depth of three feet. The receiver is not protected and needs to stay poolside, however, if you are within 10 feet of the receiver you can still get readings, which means if you start to go low while swimming, you can take action.

I leave on another trip to snow and cold on Dec 27 through Dec 31. I am going dog sledding, so I'm glad I'll have the Navigator watching over me.

My blood sugars have been really all over the place last day and a half. I changed my infusion set on my pump, but I am hoping things settle today (especially with the Christmas parties this evening).

Will be checking in infrequently over the Holiday break. Happy New Year!

Tuesday, December 19, 2006

Day Eight: CGM Trial

Today was a very busy work day for me with a PR event downtown. Thank God I had the Navigator because I would have gotten low and never know it. I was running around like crazy coordinating things when I got a warning. I stopped what I was doing, went into the neighboring restaurant and asked for some Coke and proceeded to get back to work with very little interruption.

No emergency, no panic, no worry. I just got it taken care of and it wasn't an issue.

Regarding the sensor and transmitter being in the back of my arm, it was a little uncomfortable last night in bed when my arm is flat against the bed. Turning over on my side, I felt like it was in the way, but throughout the day it has served me well.

Someone asked about comparisons between the Navigator and the finger sticks on my previous post. I did a few in the first few days with very comparable results, but this is a good idea and I will do more in the coming weeks, so look for those.

This is my second calibration with a new sensor (you take finger stick readings at four different intervals from the time you put the sensor on and it becomes active to calibrate it) and I had a discrepency between the Navigator Finger Test and the Navigator CGM readings today by 30 points. I was also hitting a low at that time, just after my event when I waited to take action, so the calibration isn't very effective if you are swinging high or low, so I'll report more as I experience it.

Two more comments, the Navigator screen is plastic and it is becomming really skuffed up pulling it in and out of my pocket, where I think most people would wear it. I also think the read-outs are hard to see without the background light. I have good eyesight, but the black letters and numbers are small (except the blood sugar number) and the grey background is just tough. I think this could be a real issue for people that are older or have vision issues. Wish it looked like the screen of my Palm or cell phone.

Second, I am irritated with the menu and scrolling options. If you go to a report and decide to look at the two hour screen, rather than the four hour that you originally selected, there is no back button. You have to wait for it to time out (12 seconds in the regular menu and longer, maybe 20 seconds on the reports screens). This wastes time and seems like a silly amenity to leave off. You have to wonder who decides what options to include and which one's have to go, and why.

Traveling all day tomorrow, so may not have time to post, but I appreciate those of you sending comments.

For those of you that currently have a CGM, can you post a comment about whether you were able to get insurance to cover it and all the supplies? I am very curious about this and would appreciate your feedback.

106 and heading east-->

Monday, December 18, 2006

Day Seven: CGM Trial

I went to see my doctor today and got a new batch of supplies for the Navigator. I also learned briefly to use the software and I really like what I've seen.

My favorite part of the software is a Daily Combination page that shows blood sugars on a line graph and meals directly below the blood sugars, using circles that are relative in size depending on how many carbs are eaten. Below that is a bar graph showing insulin dosage. I am a very visual person, so I completely dig the small and large circles, right under the line graph. It is so easy to see where you need adjustments based on pre-meal, post-meal and all in relation to insulin dosages. When I get the software downloaded (after the holidays) I will post a screen shot of this page. With the software I went over my readings with my doctor and it was great. We were able to balance my basal vs. bolus ratio in a way that never would have been possible with 4-6 finger stick tests. He loved seeing the line graph floating in the low side of my goal range for hours and hours.

I inserted a new sensor in my left arm this time and it bled for a bit, but we dabbed at it with the corner of gauze until it stopped. Totally no big deal. The insertion was relatively easy. I twisted my straight arm and crossed it over my chest so I could reach the back ; where most folks tend to do injections. I was able to do it one handed, but I would need a mirror to check the insertion and check for blood which can impact the sensor negatively if there is too much. It was a little tough to get the transmitter snapped into the sensor today. Not sure if it was my arm postion or the unit.

I did not use Tegaderm as I need to remove the sensor Wednesday morning and I'd like to see how well the adhesive does this time. I have to wait 10 hours from insertion to get readings.

Basically, the 10 hour window is said to be there because when you poke a hole in your skin, there is trauma. The tissue needs time to heal before it can take readings of the interstitial fluid effectively. That could be two hours with some people and much longer with others, so ten hours should be safe for most everyone to get good readings. Once the ten hours are up I will calibrate the Navigator with a finger stick, using the Navigator receiver, which is also a stand alone meter. I will have to check again in two hours, so that will be late tonight.

Next post I'd like to start a dialog about cost and insurance. I am very concerned about the cost of CGMs and sensors, as well as the timeline when insurance campnaies will begin picking up some of the bill. This technology WILL save lives and WILL save $$$ in emergency room care, not to mention the opportunity to prevent or prolong the onset of serious complications.

I should note that my decision to start this blog was because I felt totally compelled to share this information with my family and anyone interested in the technology. It is not monitored by anyone with the study, in fact, they have no knowledge of this blog. The information I am communicating is based soley upon my personal experiences. I am not a doctor, just a woman living with diabetes and caring for a chld with type one diabetes. If you have any questions about whether a CGM is right for you, talk with your doctor.

Ahh! My navigator just beeped for my first calibration--150 and doing great. Let the readings begin!

Sunday, December 17, 2006

Day Five & Six: CGM Trial

Well, Thursday and Friday my daughter was sick, fever and coughing mostly, and her blood sugars went through the roof. It always surprises me how fast ketones develop in children. She was diagnosed with a sinus infection. I don't have much problem with illness and ketones these days--don't know why, but I am thankful.

The CGM has been amazing. I have had so much fun watching the line graph hover between 85 and 100 for hours on end. I still have peaks and lows, but I need to get some basal and bolus adjustments made. The Tegaderm tape is awesome and the unit feels so much more secure against my body. I may put it on immediately with the next sensor.

Friday afternoon around 5:00 p.m. I started to feel really bad. I have had a cough for three weeks that the Dr. has insisted would go away on its own, but I developed a fever. My blood sugars only rose slightly, but it was SO nice to look at the receiver and KNOW where I stood. I rose into the low 200s, put a temporary basal of 130 percent and came down. Being sick is hard; being sick with diabetes is harder; being sick with diabetes AND having a child with diabetes (who is getting over being sick) is just mind numbing. I was totally exhausted yesterday and just did a lot of time in my hammock outside in the sunshine (gotta love Texas--40 degrees one day, 75 and balmy the next).

Yesterday, I got a warning that my sensor had to be removed as I had reached the 122 hour limit, so I removed them easily. You can't keep wearing the unit to stretch your dollar, it will not transmit readings past 122 hours. I was pleasantly surprised that the tiny hole in my skin was not
irritated, the area around it was fine, they only side effect was some residue from the adhesive on my skin.

To my disappointment, I was not provided with another sensor. Tomorrow I go back to be trained on the software and to get a 30 day supply of sensors, as well as insert the new one with their help. I am going to try the back of my arm this time. I am really curious how that will work. I didn't mind my tummy, but that is where I wear my infusion set is almost exclusively and that's a lot for a tummy to handle.

I can't tell you how much I miss this thing when I'm not wearing it. As far as comfort goes, I felt much better about wearing the transmitter after I put the Tegaderm on. The thing is kind big, relatively, so it just felt better with some adhesive support. However, it is much more comfortable that I imagined it would be when I first saw it. Maybe it will be different on my arm. I shot some photos of the sensor itself without the transmitter The sensor is a chip with a tiny tube and only goes 5mm under the skin. My infusion set is 9mm, so this is nothing.

I am already worrying about not having this at the end of the 90 day trial. I really want Minimed to make their transmitter smaller, so I can use it with my pump. The idea of those two devices working together is just awe inspiring, but comfort first and their current model is just too big.

Feeling much better today, but I miss the Navigator. After my temporary basal went off, I found myself at 325 mid-morning. I never would have gotten that high if I had the Navigator on. I will have to travel on Wednesday for business and you have to remove the device before plane trips. It is a one day trip, so I will just take it off Wednesday morning and put it back on when I get home that afternoon.

I'll post after my appointment tomorrow, which could run two hours (how much could there be to know?).

Thursday, December 14, 2006

Day Four Continued

I averted a low today! I got a 30 minute warning of a low when I was 153 and on a walk. I got myself home and drank a juice at 105. My B.G. dropped to 88, but turned around before I got lower and I stayed around 112 until dinner.

Nice! Check out the Line Graph over two hours.
I was dropping at about 5:00 p.m. and it turned just after 5:30 p.m.
I am pretty impressed. I always thought about this thing in terms of warnings for lows, not about the opportunity to avoid them. I also thought about it in big wide statements to gain better control, but the idea that this could help prevent an emergency is amazing to me. I have read about the technology for awhile, but to experience it is something else.
Today I barely looked at the thing (compared to my obsessiveness for the past few days), but the alert was very helpful!
Regarding adhesive, it is stuck on good, but the edges are flapping in the breeze. I like the idea of Mastisol, so I may pick that up if allowed through the study.
Got another Projected Low Alarm at 11:30 p.m. and avoided getting low. I was 115, but I drank some juice and I am 95 and holding steady 20 minutes later. Can't wait to see my Dr. on Monday and get some numbers straightened out based upon this tighter control. Also, anxious to know what my A1c was to start this project.

Day Four: CGM Trial

My daughter is watching all this carefully. I am extra sensitive to the serious pain in the neck of blood sugar checks for her as I wear the Navigator CGM. She said she was super hungry this morning and I pulled out the B.G. kit to check her, worried about a morning low. She was 160, actually just hungry, but the fear of my daughter going low in the night is always with me.

I always check her before I go to bed, usually between 11:00 p.m and 1:00 a.m. as this helps me fall asleep.

I titled this blog Diabetes Self-Care: Balance for Families Living with Type One because I have been working for the past year to create better balance in my life as a mother/wife and woman. I left a high profile position in the music industry to work for myself and to develop a deeper relationship with my family and myself.

My daughter was going to be starting Kindergarten when I left that job and the idea of managing her diabetes while traveling monthly and working 60 plus hours was daunting. The process of educating school staff on how to care for her was not easy, but I did it without fear, as I was literally three minutes away if an emergency arose working from home.

Today she is in first grade and she handles the role diabetes plays in her life well. She still asks me when a cure will come, but we stay positive and I try to teach her as much as I can about taking care of herself. She has competently taken her blood sugar almost from the beginning and her math skills are super sharp due to all the carb counting. She reads food labels with ease and she administers her own insulin via the pump with supervision.

One thing I want to instill in her is that knowledge is power. Fear of this disease gets us nowhere. The more we know, the easier it is to handle, which is evident by the information I am receiving through this study. I see mothers of children with diabetes as freaked out as my mother was when I was diagnosed and there is great reason to be concerned, but from the time I was 15 I understood that this is something I have to contend with and I can choose how to manage it; from fear or from faith and hope. My years of living with diabetes have made me a stronger mother and advocate for my child.

Day Three: CGM Trial

Day three was a little rough. I woke up having been in the low 200s all night, got more stable throughout the day and then changed my infusion set around 6:00 p.m.

I experienced the same lows beginning at 8:00 p.m. I did the night before and the warning system seems to be off in terms of time. Who can predict the exact rate a blood sugar will drop; the Navigator does provide a warning and I have it set to give me 30 minute notice, but I drop really quickly and the High sensitivity setting really only gives me about 10-15 minutes.

I got another warning around 9:00 p.m. that I was going to be low and my blood sugar was 105. I immediately drank some milk and it dropped to the 60's before it began to climb.

I am making an adjustment on my pump today to reduce my meal bolus for dinner time and we'll see what happens. My night was interesting as I hit about 180 at 2:00 a.m. and dropped very slowly all night to 64 at 7:00 a.m. Interestingly, the Projected Low Alarm does not sound if the blood sugar falls very slowly and the arrow is ->. It only sounds if it sees a noticeable downward drop, so I was awakened this morning with a 64, but at least it woke me up. It is thrilling to think I would get an alarm while I sleep if things get dangerous.

Had significant problems with the adhesive on day three. The tape is slowly lifting all around the transmitter site, so I put some IV 3000 adhesive film over the whole site. Within an hour it was itching, so I peeled it off to find a red rash around the edge of the adhesive and the glue stuck tot he transmitter and is now sticking to my clothes.

I have different adhesives to try to keep this thing on, but am apprehensive about trying another one. I have used IV 3000 before with no reaction, but I guess if I want to keep the thing on, I'll have to give another one a try.
© 2007 Photo by Wendy L. Morgan

Tuesday, December 12, 2006

Day Two: CGM Trial Continued

Wow! This thing works and I have had very tight control all day until this afternoon. I got a warning around 6:00 p.m. that I would drop from my current reading of 90 to 65 in 20 minutes. Boy, did I drop.

I was getting kids home from Girl Scouts when at 6:15 I hit 65 and fell steadily from there. I felt fine, no symptoms really, but by he time I reached our local taco joint, I was 58, before then could bring me a drink I was nearing lower 50s, before I could digest the drink, I was in the 40s. It took 15 minutes before my arrow began to show a climb. I was still under 65 when I finished dinner.

When I hit 85 after dinner I administered insulin for my food, only to get an alert at 8:00 pm warning that I would drop from 80 to 65 in 20 minutes. I immediately got some juice, but dropped to 65 within five minutes. I am at 53 now and the arrow is pointing South East, which is up from a dead south direction.

My average since 10:00 p.m. last night has been 137 with 68 percent of my readings within target range, 23 percent above (70-160 is target for me) and 9 percent below. Not bad considering my highest sugar has been 211.

It takes me a lot longer to climb from a low than I thought. I really thought I was up after ten minutes or so, even though I know all the books say fifteen.

My daughter was fascinated, but a little freaked out watching me drop at dinner. She knows what those numbers mean, but I assured her the body takes time to rebound once you drink some juice, and that I would be fine, but watching me hover so low for about 10 minutes was slightly startling.

I am 58, but the arrow is now due east, which means I should be climbing soon. I am changing my warning to a 30 minute advance and see if I can't stop these lows.

Day Two: Continuous Glucose Monitor Trail--Thrilled!

So, I had to calibrate the CGM at 2:00 a.m. last night, but that was only because of the timing in putting it on, but since then my glucose readings have been tracked every single minute since about 10:00 p.m. last night.

I saw a trend at 5:00 a.m. where my blood sugars rose fro the 130s to about 200 and stayed there until I woke up around 7:00 a.m. I did a bolus adjustment on my pump and have hovered around 125 since then. Actually in the last hour I have slid to 88, but the Navigator shows me as stable, neither trending down or up, so I think that came about fairly gradually.

I have access to a line graph that show my sugars in 2, 4, 6, 12, 24 hour increments and this is very helpful is following trends. I will see tonight if I track high from 5:00 - 7:00 a.m. and then consult my Dr. for a basal adjustment if needed. Do you know how amazing this is? To know when your hormones kick in and be able to make micro adjustments is astounding!

I am totally fascinated by this--I can't believe how much this lessens the stress. My husband Marshall say he feels less stress too, knowing that I actually can "see" I'm ok, rather than me just saying, "I'm fine," using my instinct and how I am feeling.

More later in the day on device, although I need to make one note--the adhesive began coming up on one side last night.

Monday, December 11, 2006

Day One: Continuous Glucose Monitor Trial

I know what my blood sugar is right NOW!

. . . .and NOW!

. . . . . . . and NOW!

. . . . . . . . . . . and NOW!

I am Wendy Morgan and today is the first day of a trial I am participating in with Abbott Labs for the Freestyle Navigator Continuous Glucose Monitor. I am officially the first person enrolled in the trail and about one hour ago, I got my first reading from the Navigator.

I have had type one diabetes since I was 14 and utilize a Minimed Insulin pump now, after some 12 years on the pump. I jumped at the chance to try a CGM because I am incredibly sick of feeling guilty for not checking my blood sugar more often. I am in moderate control, A1c was around 7.6 a few months ago, but I am an extremely busy mom (of a daughter with type one) and married to a great man with type 2.

I spent three and a half hours in training this morning and the device is incredibly easy to use, but what is so amazing is how it lets you not only see your blood sugar, but it also calculates the trend. Right now the Navigator shows my blood sugar is 128 and an arrow is pointing east, which means my sugars are trending at a stable level. If the arrow points NE- I am trending slightly up, N - it is going up, SE - going slightly down and S - trending down.

Another amazing feature is that the Navigator has an alarm that will alert you when you are 10, 20 or 30 minutes (at your discretion) away from a high blood glucose reading or a low glucose. For instance, if I am 90 at noon, 80 at 12:20 and I am 10 minutes away from hitting 70, an alert will sound and help me prevent hypoglycemia. Same goes for the other direction.

Tomorrow I will talk more about the actual device--first impressions after a night of wearing the thing. I will say it is comfortable so far--keep your fingers crossed. 131 ->