T:slim in Action - Correction Bolus

I was disconnected for longer than I intended this morning (forgot to reconnect after my shower), so I checked my blood sugar and took a correction bolus. And I did it all on video. Spooooky.

Okay, not spooky. But it's Halloween and I had to acknowledge it. What will be spooky is my post-trick-or-treating-barbecue-feasting-with-friends blood sugar tonight.

Where No D Has Gone G4

Though I know of people who were lucky enough to be guinea pigs for the Dexcom G4 Platinum CGM system, I think I am one of the first D-bloggers to start using it officially. I've been operational for 12 hours now. Yeah, yeah, shut up and get to the photos.

I ordered their Ocean Blue. I think it looks darker than the photo on their website. Considerably. Still, I love blue. I'll take it.

Ocean Blue

Product Image from Dexcom.com's webpage - I like their blue better

What Came in My Shipment

Transmitter

The transmitter has a six month lifespan and apparently they are fairly serious about this. The box comes with instructions (I also received these instructions from my local Dexcom clinical rep) that removing the transmitter from its position in the box immediately begins its life (aka warranty) and that I should wait to remove it until I was ready to begin my first sensor.

Dex 7+ transmitter next to G4 transmitter

The transmitter is roughly the same size in length and width, but much thicker/taller. Matte finish, too.

What's in the Receiver Box

The box with the receiver comes with a tutorial CD, a user's guide, a wall adapter, a charging/syncing cable, and a leather belt clip case that snaps shut (designed with a man in mind, I think, as it includes a snap loop to go around a belt - Hubster had to explain that one).

Receiver

With 7+ and Verio

You slide the little port cover closed when not charging.

Super Skinny

With t:slim. Will the real Slim Shady please stand up?

Slim enough for back pocket carrying.

Sensor

60% smaller sensor than the 7+ (image emailed to me from my clinical rep)

(image emailed to me from my clinical rep)

Start Up

Symbols: In range, full battery, no reading yet, and - uh-oh ???.
But it worked itself out by the 2 hour calibration time.
In other news, I was their first tech support call.

Up and Running

After calibrating to a 123 and a 133, I got my first reading immediately.

The alert screen for the low threshold I've initially set (YDMV)

The alert screen for the high threshold I've initially set (YDMV)

Accuracy

I think 12 hours is too soon to say. Before I went to bed, it said I was 108 and rising, but my fingerstick revealed I was over 200. I recalibrated and, a few minutes later, it asked me for another calibration. Then it seemed to stay right on track through the night.

It's alarms? Customizable to a degree. I have it set on the loudest, most annoying setting. It woke us in the night to say that I was below 55 and I corrected with a juice box. Woke at 74 this morning (fingerstick) and G4 said I was 76. Not bad, G4. Keep up the good work. I think I'm "falling" for you.

Arts & Crafts Day

Okay, so Sweetie and I had ourselves an Arts & Crafts Day.

I dabbled in my first non-food Pinterest project - a menu board.

It took me ALL DAY.

Sigh. Alllllll daaaaay.

I started at 8:30am. Hot glue gun, a broken repurposed cutting board, popsicle sticks, cardstock, ribbon...

By lunchtime, I needed Sweetie to eat three small boxes of raisins so I could make my little boxes (for Poultry, Soups/Seafood/Slow Cooker, & Red Meat).

I worked on it in spurts throughout the day. If you have a 2 year old, you know that everything takes longer with help. My office is a disaster as all the crayon wrappers were peeled away, boxes of stickers dumped onto floors, ribbons streamed across the sky.

And as my family slept peacefully just after midnight, I finished up the last of my ingredients for the backs of my 52 little cards. Wow.

I now have a (rather obviously) handmade version of the same information I keep week-to-week on a Note on my iPhone - but now with shopping lists so that I don't have to sit and make my weekly lists while referencing countless cookbooks and online sources. And it's kitschy...for my kitchen.

I mentioned it was Arts & Crafts Day for both of us, right?

Well, Sweetie found a pencil and some scrap paper and made her first unprompted drawing. She has scribbled lines on a MagnaDoodle here and there before, but I finally got real art from her. A defined shape with purpose.

A round shape. A pretty good one for a first circle - meeting completely and everything. And two eyes that I watched her draw but the mechanical pencil lead wasn't advanced enough to show anything for it. "Cat," she said to me.

Cat

You're damn right it is, Sweetie. That's most definitely a cat.

Arts. Ur doin it rite.

t:slim review

UPDATE: I am no longer using the t:slim pump. It wasn't the right choice for me after all. I had issues as an Apidra user and had concerns about inconsistent basal delivery and worsening control. I understand I'm part of a small but significant group who had trouble, but Tandem is listening to the handful of us with problems and hopes to resolve them. Anyway, here was my initial review.

I started pumping this week with the new t:slim insulin pump from Tandem Diabetes Care. I have been watching and waiting for this pump to come to market for years and can hardly believe it's ticking away on my waistband as I type this.

This is not me typing this.

Many of you have been asking me how the t:slim compares to the pumps I've used in the past.

Here is the t:slim pictured with the three pumps I still have in my possession: the Omnipod first generation PDM, the Omnipod UST200 PDM, and the Deltec Cozmo 1800 (my 3 Medtronic pumps went the way of trade-ins). It's slimmer than any pump I've used before - about half again as thick as my iPhone 4S in its Speck case. Not THAT much slimmer than a Medtronic or Animas pump, but still thinner. (I compared it to my student's Paradigm and it was only barely so.)

I know - he's delicious.

My favorite part so far is that they moved the luer lock connection further down the tubing so that there is no stress on the tubing where it connects to the cartridge. I've had a baby or a toddler on my hip for the last couple years. When wearing a tubed pump, I frequently poke them with the luer lock cartridge port on my Cozmo. Not now. Clearance for those yummy chubby thighs.

Insets, IV prep, Verio IQ, cartridges/syringes/needles
t:slim box, charging cable, adaptors, cartridge remover keyrings,,
and the user guide is a business card thingy w/ USB input - wow.

The supplies take up more room in my meter case than I'd like. Your set change and cartridge implements are essentially in four separately wrapped pieces - 1) whatever infusion set you choose (I'm using the Animas inset, my favorite), 2) a flat black cartridge, 3) a fill syringe, and 4) a capped needle similar to the Omnipod fill needle. They package the latter 3 implements in one small black and white box, so that's nice. I just have to make sure I grab one of each item. Consolidation would have been nice.

I am always critical of pump clips and the t:slim delivers nicely on that point. A swivel belt clip with a soft felt lining to help the cased pump slide in and out. I'm looking forward to the t:clip, too - a case+clip in bright colors being developed by Myabetic.

Charging Cables and Assorted Tech Gear

Charging cables. I have a bone to pick with Tandem about charging cables. The t:slim's revolutionary lithium polymer battery requires a charge once every 7 days and does well if topped off for 10-15min every day. They send you a USB wall charger and a USB car charging adaptor (for a cigarette lighter) - and only one cable. One.

Luckily, I keep a spare micro-USB cable in my car for my husband's Samsung Galaxy series phone and it easily topped the battery off while I was driving today. But why send only one cable? Isn't the point of having the car adaptor in case I need to charge it on the go? Do they really want me lugging a cable around in my supply case or my purse? Have you seen what I do to headphones?

Thank you, Samsung. Apple, why you gotta be so proprietary?

Touchscreen. Oh my heavens, it's lovely. The glass and the colors (which denote different information types and whether or not it's a value that can be changed by the user) are crisp. It's not exactly like using an iPhone, but you can quickly adapt to the required pressure for button pressing. The touchscreen input means that you can pair it with any blood glucose meter you prefer to use. No scrolling up and down to input blood sugar values. Just a quick keypad input for BG and for carbs.

Touch me.

Carb calculator. This was the feature that surprised and stupefied me. There is a calculator for inputting your mealtime carbs. Sandwich was 28 and chips 17? No problem. Press "28 + 17 =" and hit Done. I'll never do addition again.

6th grade math teacher: You're not going to have a calculator
on you everywhere you go. Ah, how far we've come.

I LOVE that they have delivered on a failsafe for insulin overdose. There is essentially a holding chamber that they call a micro-delivery chamber in the cartridge that can hold less than a unit of insulin at a time. You're not ever at risk of a pin or plunger suddenly delivering the entire contents of your 300-unit reservoir into your body. Whew.

Loading the cartridge. There are three little idiosyncrasies about the way you fill the cartridge and tubing for the t:slim. 1) The cartridge is inserted before you fill it with insulin. 2) The fill syringe needle is very long, yet only the very tip of the syringe is inserted into the fill port. You feel a little pressure and stop. How many people will break a needle attempting to jam the whole thing into the fill port? Very odd. 3) When priming insulin into your infusion set tubing of choice, prepare for a wait. I'm a 23" tubing length user myself (short length) and in the time it took to fill the tubing completely, I could have gotten up and made myself a cup of coffee. Or gone to check the mail. It takes that long. Hmph. Update: I timed a prime and it came in just under 02:30. =\

So much makes SENSE about the way this pump works. If you time-out on a screen and go back into the pump, it remembers what screen you were on. It pulled the best features from the Cozmo pump (a site change reminder every three days, a missed meal bolus reminder) and the large reservoir capacity previously offered only by Cozmo and Medtronic.

The best feature, hands down, of the t:slim is the way it presents your settings to you.

With the other pumps currently on the market, the user is able to set multiple basal insulin profiles (for work, for weekends, for differently scheduled school days, etc), but you can't create multiple profiles for your correction factors, your insulin:carb ratios, or your target blood sugars. Those are stuck. When I was preparing to go into the hospital to give birth to Dibbs, I could quickly switch to a post-partum basal profile, but I had to go in by hand and change all of my settings in the other screens.

The other pumps split this data into multiple screens, embedded in different areas in the pump.

Omnipod

Cozmo

On the t:slim, it's all in one place. One place. ONE SCREEN EVEN. I can create (and even duplicate and then edit) profiles that are displayed based on time of day. I can look at a glance and see if my correction factor may be overcompensating for my basal rate being off. It's all in one location.

These settings were set by my Evil Genius CDE in regard to my
personal blood glucose trends. Please do not make adjustments
to your regimen without consulting your physician.

From the lock screen, I can see the time, date, battery life, insulin volume, and my insulin-on-board amount and time remaining.

Easy as 1, 2, 3.

And if I go into my History and click Delivery Summary, I can even get a visual breakdown of my usage for the day or over different specified periods (7 days, 14 days, etc).

Rock me, Amadeus.

This baby seems to have it all. I'm excited to see where this company is headed with their future iterations of the t:slim and I'm thrilled to have another competitor enter the market to push their rival companies to keep innovating for the end user.

I have consistently said two statements over the years when talking to people with diabetes about our available choices in regard to insulin pumps: "There is not a bad pump out there; they all get the job done." And "No one pump has everything I'm looking for."

I'm optimistic that I might be able to stop saying the latter.

Baking Cake Pops

October 1st is No D Day.

In honor of the event, I won't just be blogging about something other than that topic. Let me see if I can finish this post without that letter. :) Channel my inner English major. My brain is its own thesaurus.

I want to talk about baking.

I am an okay cook. Better than okay, perhaps. But I am still in my infancy. I cook five nights a week. Six if you count that one night a week we reserve for leftovers. My week usually looks like this:

Su: big batch of something
M: leftovers
Tu: chicken
W: crockpot or soup
Th: chicken
F: pizza
Sa: sausage/pork

But I've been working on my baking skills recently.

Project of the Month: CAKE POPS

To begin, my mom bought me Bakerella's "Cake Pops" book. We went to Michael's to buy lollipop sticks & melts. But I have been saving the pretty purple coating melts for later this month, so I ran to the supermarket for cheap chocolate & vanilla coating - right on the baking aisle. Perfect for some test batches.