Tidbits and Tricks

Today's Prompt: Learning. Share something you learned from another Health Activist (that everyone should know!).

First of all, I am not a licensed medical professional. I'm not trained to give advice on anyone's diabetes but my own.

That being said, I want to share a revelation that I picked up online that changed the course of my diabetes. It changed my blood sugar spikes. It lowered my A1c. I credit this piece of advice more than any other in getting my body ready for pregnancy. It changed everything.

It matters when you take your insulin.

Online we call it pre-bolusing.

The last few years, continuous monitoring has taught medical professionals a lot about how insulin works in the body. When the newest fast-acting analogs came to market, we were told we could take them right on top of meals. When my doctor started me on Apidra just after it was approved by FDA, we thought it would help me because I usually bolused after meals and this insulin would supposedly accommodate that habit.

Fast-forward to the days of continuous monitoring.

We now know that the "fast" insulins are not as fast as we thought. When taken on top of (or worse, after, meals), Humalog/Novolog/Apidra miss the post-prandial (post-meal) spike entirely. They should be taken earlier. I won't give advice on how early, as I think it can vary from person to person, but I know how many minutes before the first bite of food works for me at most meals.

The pushback I get from most people when I suggest pre-bolusing involves one of the next two arguments: 1) But what if I go low before the meal? and 2) But who knows how much little Timmy will eat? It's easier to bolus afterward.

I'll address each of these valid concerns.

First Impressions: The New Omnipod UST400

I started today on the newest Omnipod Insulin Management System, the UST400. (For an update on how I'm doing on the new system after one month, click here.)

For those following my ongoing pump parade, I had left Omnipod last year after over 3 years on their UST200 PDM and original pods because I was frustrated with kinked cannulas and occlusions. From there, I jumped back and forth between my out of warranty backup pump (the Cozmo 1800) and my brand new shiny Tandem tslim (that hasn't worked out for me).

And through a strange set of circumstances, I found myself back at Insulet's door just weeks after their new, smaller Omnipod system had been released. Right as my original Omnipod system warranty expired. Right time, right place, and hopefully an improved user experience.

These are my first impressions.

Tired of Betting on the Underdog

Like a die-hard Betamax fan, my status in the world of CGMS users has been one of being the weird outsider, talking about a product that no one else is using.

I've been sporting the Freestyle Navigator CGMS since November of 2008 - over two and a half years. It blows the other CGM systems away for:

Accuracy - It's usually within 0-4 mg/dL of my Omnipod PDM or my Flash or my Cozmo.

Comfort - You wouldn't believe how much tinier and more comfortable (and not wire-like) the sensor is if I showed you. Here. I'll show you next to Sweetie's pacifier.---->

Ease of Use - When the Dexcom 7 (pre-plus) was still showing you only the last few hours, Navigator had onboard range and standard deviation stats for 1, 3, 7, 14, 21, and 28 days, an endless history of graphs, etc. Not to mention only 4 calibrations every 5 days. It uploaded to CoPilot, just like the Freestyle meters, Cozmo pump, and Omnipod pump, and integrated all of your data into one seamless line graph and logbook.

And the single biggest arena in which it bested the competition…

RANGE. I can be anywhere on my property (upstairs, downstairs, outside) and my receiver will pick me up, faithfully noting my per minute (not every 5min) changes. For parents, that means they can sit comfortably on the sidelines of the basketball game and watch Susie's blood sugar. That means they can keep the receiver by their alarm clock in the master bedroom and Jimmy can sleep upstairs in his room without Mom and Dad straining to hear the low alarms.

For adult patients, it means you can leave the receiver in your purse under your desk, walk to the bathroom, and not lose a signal. You can be upstairs, passed out in the shower, and your husband will hear the low alarm downstairs and run up to check on you (actually happened to a patient of my CDE's).

And herein lies the problem. Abbott never sold you on the range. They didn't even train their meter people to know the details of their CGMS. I have taken over the Freestyle booth at many a vendor fair and run the half of the table talking about their product when it was clear the rep just wanted to tell people about their non-coding meters. A failure in marketing. Bullshit. Out of touch with the consumer.

In a meeting with some of their engineers in April of 2010, when we were first discussing the indefinite backorder and production freeze of their device (and how it was all red-tape legal mumbo-jumbo regarding the production rights when Abbott bought the Freestyle brand from Therasense), I was asked as a patient representative if I would trade range for a smaller transmitter.

What? Really? Okay, well, the Dex transmitter is half the size (though the wire below is longer). It's sleek and sexy. But I hated having to carry the big old Dex receiver on my body. I wear a pump already. At what point do I need Batman's toolbelt to hold all my gear?

But I don't think I can stay in this relationship any longer. I'm not going down with their ship. And after talking to both my CDE and my friend who used to work for Abbott today, I've made up my mind.

The backorder on my barely broken (and still usable) transmitter has now persisted to the 18 month mark…and it is rumored that at least another year will pass before it's lifted. I have three sensors left. And Abbott will give their customers $2,000 to stop complaining and just go buy a Dexcom already.

It's time for me to shut up and do it.

With only a few reservations, I'm taking the payoff and switching to Dexcom - a company that will eventually release their next gen (come on, FDA) and eventually integrate with my pump (COME ON, FDA). A company that knows how to treat their customers.

But a part of me will always resent that the rest of the DOC didn't know what they missed out on. I was the crazy chick crying out in the desert about the Nav while others complained about inaccuracy or harpoon needles (looking at you, Minimed), or the Dexcom's ???'s and quirky relationship to acetominophen (not an issue with the Nav).

In the end, just like when I bought a Cozmo 9 months before that company went belly up, perhaps it would have been better 'never to have loved at all.' It only makes me irritably cranky that I got a peek at something great that wasn't meant to be.