It’s The Difference Between a Flip Phone and a Smartphone

Hey there.

I’m still here in the bathtub.

Sorry – elementary school teacher in me sneaking out referencing a children’s book of poems.

I can’t remember the last time I wrote, and I’m too lazy to click back on archived posts – Im guessing the last post would be archived since it’s defiantly been a long time.

I could give you a list of reasons why I’ve been absent but it would bore you, so lets just pretend I’ve been in a drunken stuper for how ever long it has been. I haven’t of course. I really don’t drink. In fact, I was recently chatting via text with another Dmom about how I should drink, and I wondered aloud (can you wonder aloud via text?) fuck it anyway, I wondered why I didn’t drink and she was able to remind me, because as a parent of a child with diabetes Dmoms or dads, need to be on 24/7. That made me think of the last time I had more than 2 adult beverages. I knew of course. It was December 2010. I had hosted a BUNCO party at my home in Texas. Thirty of my closest friends or women with no better plans were at my house. I had consumed copious amounts of red wine. I remember checking my youngest sons blood sugar before going to bed, technically before vomiting a few times and then going to bed. I know I set an alarm for 3am to check my youngest again, but I didn’t get up and I didn’t ask my husband to get up either. I don’t remember much of the evening after the party. The next morning when I checked my son his blood sugar was 32. For anyone not in the diabetes know – that is exceptionally low and dangerous. That was the last time I consumed more than 2 adult beverages in one evening and even that is a rare occasion.

I digress – this post isn’t about adult beverages or the dangers of caring for children when under the influence. I honestly don’t get what is fun about being intoxicated. I’m a bit of a control freak so the thought of not being in control kinda makes my skin crawl.

Still more digression – this post is about insulin pumps. Or it will be if I ever shut up about alcohol.

My oldest started using the Tandem T:Slim insulin pump in December 2013. It is a sexy pump. I mean if pumps could be considered sexy.

The other night my daughter inadvertently let her pump (Dorothy – her pumps name is Dorothy) die. The T:Slim is a rechargeable pump (woohoo – planet Earth friendly) but if you don’t charge it, it dies. After it dies and is then charged the insulin cartridge must be changed. I don’t know why. It just does. Just like with the Animas Ping – if you change the battery the pump also requires a full rewind and load of a cartridge, thankfully with Animas it can be the current cartridge, not so with T:Slim. Sorry jumping ahead – I’ll get back to Animas in a few paragraphs or one paragraph – I really don’t know since I haven’t written it/them yet, the point is I’ll get back to Animas.

So Dorothy is dead. It’s late at night and my daughter had just gotten into bed. I was making the rounds to the kids rooms saying goodnight and tossing in some late night criticisms of messing rooms and such when my daughter told me Dorothy had died but she (Daughter, not Dorothy) thought she could try to use the same insulin cartridge. I went back downstairs. She (daughter again, not Dorothy) sent me a text telling me she did need a new insulin cartridge and would I please come get her pump and do it. Ugh. I told her to bring it down. Instead my husband said he’d go get the pump.

This is where the flip phone vs smartphone title will start to make sense. Just hang in there.

So my husband retrieves the T:Slim pump from my daughter. Upon his return to the kitchen he asked (for the 4th time in 2.5 years) why she (daughter) was using the T:Slim instead of the Animas Ping which both boys use.

I went into a quick – ‘her diabetes, her choice’  spiel but he (husband) was not convinced. The tech guy in him wanted to know what was so great about the T:Slim, why complicate our lives by allowing various pumps in the house, blah blah blah.

My spiel about ‘her diabetes, her choice’ wasn’t going to cut it so I had to get technical.

For over 9 years one or more of my kids have used the Animas pump, currently both my boys use Animas Pings. My youngest started on Animas six months after diagnosis. It wasn’t a Ping initially, but we upgraded as soon as the Ping came out because HELLO remote bolusing. The Ping is great, but it hasn’t changed even one little bit since it debuted nearly 9 years ago. Yes, Animas came out with the Animas Vibe, but now with the Dexcom G5 available that uses a smartphone as a receiver, the vibe is really quite obsolete. The Animas Vibe is an insulin pump with a built-in Dexcom CGM receiver so the CGM data can be displayed on the pump screen. The worst part of the Animas Vibe is when they added CGM they deleted Ping technology. That, and the CGM software can’t be upgraded (to my knowledge) when it was integrated which means users of the Vibe are stuck with the same CGM software for 4 years despite advances in technology and software updates. We are used to the Animas Ping and so we forgive Animas the lack of updates. What lack of updates? The LCD screen is basic black and white, save for a few highlighted words, and to get it backlit you have to press an extra button. To get to various menus you have to go through nearly a dozen screens that you don’t need. When it is time to bolus the user must ‘scroll’ up to the proper bolus amount. The IOB (insulin on board – amount of insulin currently coursing through ones body at that moment) is multiple clicks away, as is the history of boluses, alerts, etc. Still none of that matters because PING – remote bolusing is the bomb. The kids can be in full sports gear with their pumps tucked away under layers of under-armor and pads but still dose for the 32oz Gatorade they down on the sidelines, or correct a high blood sugar without touching their pump. At night if I am checking the boys blood sugars during the small hours and they are higher than what is good for them I can bolus them without rummaging around under covers for insulin pumps.

The T:Slim,  the first Tandem pump, not the Flex, which is also integrated with the Dexcom CGM and has the same software issues as the integrated Ping (to my knowledge) is very user-friendly. Large color touchscreen, easy to navigate menus, slimmer profile, displays the IOB on the home screen, and doesn’t require user to ‘scroll’ through numbers before bolusing. Sadly – there is no remote bolus feature and no blood sugar meter linked to the pump.

Getting back to how I explain to my husband why the Tandem is ‘better’ and why my daughter wanted the T:Slim is as simple as The Animas Ping is the equivalent of a flip phone and the Tandem T:Slim is the equivalent of a smartphone.

That my husband understood.

Dear Animas – can you please recognize the importance of updating the Animas Ping pump, and for the love of Pete (I wonder if Pete feels loved?) – can you please update the Ping meter. Seriously – I have been begging you for some time to at least update the meter. The Ping meter is bulky, outdated, and uses twice the amount of blood as the VerioIQ meter (not really sure if that is accurate, but it feels like it).

Dear Tandem – incorporate ping bolusing technology into the T:Slim and the boys will most defiantly switch to the Tandem pump and I will name my first grandchild Tandem. (OK – maybe not a grandchild because I think my kids and their spouses get to name their own kids, but I will name my next pet Tandem)

I don’t know how often I will get back to write. Things are more chaotic in our home than ever before. Lots of ch-ch-ch-changes (in a few hours you will still be humming that – you’re welcome).

Writing as a parent of a children with diabetes is hard. My stories are intrinsically linked to my kids lives which are not only mine to write about.

Two of my three cwd are teens. Anyone in the know – knows that these years are hard. The stories of diabetes in the teen years aren’t always pretty. My kids are clever, kind, funny, and all kinds of wonderful but they are also stubborn, prideful, arrogant, and even – big breath – ‘non-compliant’ at times. At this point with all the non-diabetes chaos happening I’m just trying to keep my head above water and since I’m having a difficult time with life in general I have not been writing or interacting so I can focus on what is most important in our lives.

Feel free to send chocolate.

 

Did You Dose?

So Sugarboy took a shower before school Friday. Then he came down to eat breakfast. He tested prior to the shower and was high and he corrected by dosing insulin via his pump. Which (and he would be totally ticked at me for sharing this – but alas doesn’t read my blog) was why he needed a shower since he had an accident in his bed. It happens sometimes when he goes high at night. I thought he was good to go Thursday night when I went to bed at midnight with him at 178 with 0.6 units of insulin still working in his body. Unfortunately he wasn’t so he went high and thus the accident.

He finished his shower. Got dressed and came down to eat breakfast. He ate breakfast and I asked him to dose. He used his meter to dose his meal insulin (Animas Ping pump can bolus via his Ping meter). He ran off to brush teeth and hair. He had time to spare so he and his brother watched some TV while waiting for me to take them to school.

I stopped in the boys bathroom to turn off the light (they never turn off lights).

From the bathroom I yelled to Sugarboy: “Did you dose for breakfast?”

To which he said “yes”.

I said “no you didn’t.”

He said “yes I did”

I went downstairs, stood in front of him and said: “No, you didn’t.”

Without looking up he said “yes I did”

“no, you didn’t because I have your pump.”

At that point he patted around his waist, looked up and saw me holding his pump.

He had dosed using his Animas Ping meter which sent the bolus information to his pump to deliver the insulin. The pump and meter heard each other and the pump followed the instructions the meter sent remotely from another floor. Basically the pump dosed the bathroom counter.

Marcus reconnected and used the “fill canula” option to dose his insulin. He did not use the regular dosing features to dose since his pump believed he had already dosed. Dosing a second time would lead the pump to believe he had more insulin in his system than he did.

We love our Animas pumps but like any technology things can go screwy. Sometimes (although rare) the meter and pump can be less than 2 feet from each other and the meter will tell us it can’t communicate with the pump. Then there are these times (even more rare) that the meter and pump will talk to each other from an entire floor away.

From what I have heard the Animas Vibe – does not have the remote bolus feature. It had to be removed to allow for the pump to act as the Dexcom G4 receiver. Since the Vibe is not available in the US yet, and the Dexcom G4 is not approved by the FDA for people under 17 (thus not covered by our insurance) we don’t have to make any decisions regarding leaving the Ping option. But it will be a tough call once all the pieces fall together with the FDA and the Vibe. We love the remote bolus feature. Especially on nights where I need to actually use the pump to set temp basals while the kids sleep. (Remote cannot be used to change pump settings)

I do have a couple of suggestions for Animas though:

1 – provide a blood sugar check reminder alarm that can be set to alert user two hours after each meal or correction bolus.

2 – allow for multiple low cartridge alarms (blogged about that previously here)

I am grateful for insulin pumps – they make managing my kids diabetes much easier. I look forward to getting my kids the Dexcom G4 Continuous Glucose Monitors when the FDA approves for under 17 – when we test drove the Dex G4 it was the best diabetes week ever for me and both my kids. (Wish I could tell you more about our G4 experience but as participants in the G4 study to get FDA approval we was asked not to specifically blog about it)

I do want to say that I am not a pump snob. I believe that all the current insulin pumps available offer nearly the same features and get the job done. It is really just a user preference. Each pump available has slightly different features that may appeal to different families.

If you are considering an insulin pump I suggest discussing it with your doctor’s office, researching each pump online, calling the various manufactures to talk to experts, asking for opinions on twitter from people who use different pumps, consider your or your child’s life style, consider how much insulin you or your child uses in a three-day period (Animas holds 200 units – other pumps hold up to 300 units), and lastly although least important in my opinion – color options.

Here are some links to the pumps currently available in the USA.

Animas

Medtronic

T:Slim

OmniPod 

Happy Pumping all.

 

Sunday Seven

oops forgot to post – DVRd episodes of Two and Half Men got in the way.

  • Always check blood sugars before ascending 150 feet up. Kids were stuck 15 stories up on a malfunctioned ride for 15 minutes. Hadn’t checked them prior to. Yes I was freaking out.
  • I don’t feel guilt. My kids get “Special Assistance” passes at theme parks thanks to the ADA. Yes we skip lines or get a ‘come back time’ so my kids don’t stand in a 2 hour line for a ride. My hubby still feels a little guilty but my kids will live with diabetes for all their lives – skipping a few ride lines a couple of times a year  isn’t taking advantage of their disease. It allows us to attend theme parks without fear (well until they are stuck 150 feet up with no sugar).
  • Animas – please consider having multiple reminder alerts for low cartridges. One alert is not enough for a 13-year-old teenage girl. It is too easy to hit a button and move on to life’s more important things like gossip, boys, and new braid styles. Result of only one alert – daughter runs out of insulin an hour after school starts while I am 30 miles away.
  • Kids taking part in the Big Blue Test daily. As if they were not competitive enough with their numbers – the Big Blue Test has added an entirely new level of competition. I’m not complaining – they have been more active the last week than the entire month prior. Take the Big Blue Test – test your blood sugar – get active – test again – upload results to BigBlueTest.org.  Some suggestions of how to be active: dance in your cubical, chase squirrels, do lunges while shopping, dust baseboards (ok that’s not fun but when my kids tell me they are bored I make them dust baseboards and used info for BBT), and/or adult pwd – have vigorous sex – come on you know it lowers blood sugar). Click here for more information about Big Blue Test.
  • I have Dexcom G4 envy! Please FDA hurry up and approve for under 17.
  • Hiring contractor to build a bedroom for our dear daughter upstairs using a portion of our game room. It will mean giving up a pool table and wet bar but the benefit of having all my kids sleeping on the same floor as me will be worth it. No more twisted ankles due to navigating dark stairs at night to check blood sugars.
  • Just saw that DSMA Tweetchat will be a free for all on Wednesday Oct 31st. That’s just spooky. Chaos reigns. Hope some of the DOC will be available to chat it up prior to or just after begging door to door for candy. Click here for DSMA webpage to get the Tweetchat link. Chats are every Wednesday at 6pm Pacific time.

WTH

WTH – my most frequently asked question.

I’m still new at this blog thing – wish I could say I will be as diligent as my favorite bloggers and blog everyday but alas I am a mom of 3, wife, substitute teacher and not very organized regarding any of the above mentioned roles. I started this post yesterday morning and saved it when duty (also called laundry called) – the evening discussed was not last night but the night prior.

At 8pm (bedtime for my two elementary aged kiddos) we checked my dear son’s BG. He was 242 – huh? When attempting to correct his BG with insulin it was discovered that he had not reattached his pump after his shower an hour prior. My dear husband asks him to retrieve his pump from the bathroom upstairs prior to having a cup of milk before bed and all of a sudden everything hurts. His hair huts, his head hurts, his legs hurt, etc. No mention of these alignments while watching TV before bedtime was announced but now it seems his entire little body is on strike. He (ds) decides to skip the milk and requests to be carried up stairs. I holler up a reminder to my husband to attach pump and provide a correction (insulin dose). I go up a few minutes later to check that they brushed teeth (my question – “did you brush your teeth?” Nearly always is an answer in the negative at which time I make my boys get out of their beds and brush their teeth – at least those that they want to keep.) and tuck them in for the second time really since I nearly always give hugs and kisses prior to asking the teeth question. Thus a second round of hugs and kisses is needed – likely their plan.

My ds with D talked his way into my bed because his legs and head hurt. My husband and I were not going to bed but we let him lay down in our bed. At 10pm I came up to go to bed. Checked my dear daughters BG and she was right as rain (YES!), then on to my dear son. When I came into the room I could hear him grinding his teeth. That isn’t a good sign – he always grinds when he is high at night. He was 432. Thus the WTH?? He should have been in the 100s. Check the history on his pump – no correction – oops daddy forgot. But why 452? Why not just still be in the 200s? I will likely never fully understand where some numbers come from. I get the sky high numbers that come from a missed bolus – yes we have missed doses of insulin, I get the high numbers that come with sick days – dang illnesses. I get the high numbers that come from infusion sites gone bad – lack of organization leads to sites left on for more than the recommended 3 days. I get high numbers due to the beginning stages of puberty in my dd – Lord help me when we are in the thick of puberty. I get the high numbers caused by eating high fat/high carb meals like pizza – although we are getting better at combo bolusing. What I don’t get are the numbers that seem to have no rhyme or reason.

Thus, alarm was set for midnight. Midnight check resulted in in 231 so my ds was going down but n additional correction was needed. Alarm set for 2am. 2am check came up with 107. Checked dd at the same time and she was within range so I canceled the regularly scheduled 3am check and took pleasure in the following 4 hours of uninterrupted sleep.
I know not all parents of cwd get up every night, and not all diabetics themselves get up to check every night. I know many parents and and patients use CGMs (continuous glucose monitors) that alert them to rogue blood sugars. I pass no judgement on any of the decisions regarding night checking. I don’t always check at night. Although the nights that I don’t have at least one if not multiple alarms set are few and far between. Sometimes the moon and stars are aligned so perfectly that I allow myself longer uninterrupted sleep. On those nights I don’t go to bed till midnight, both kids must have numbers within range, no IOB (insulin on board) and it must have been a fairly average day with no super long periods or sitting or overly strenuous activity. You can imagine how often all the stars and the moon align in this fashion for not just one Type1 but two. Why do I set alarms and get up so often – because I feel better about them and their diabetes knowing they are safe. Knowing that if a blood sugar is high 200+ I can correct it and help keep their A1Cs (yes I know not a perfect indication of diabetes care – but a good indication of future possible complications if regularly too high) more in check. I recently spoke with a parent whose son is nearly an adult. He was diagnosed as an early teen. Her doctor told her that night time checks were only necessary the first couple weeks post diagnosis. Her son’s A1C varies between upper 7’s and low 10s. What a wild roller coaster. Yes puberty is playing a large role in the crazy numbers but still – I hope my kids will not be so wacky.
One day I hope to get a CGM on both of my kiddos. Right now the fight is ugly. Neither of them want to wear or carry an additional device. They already wear their pumps and take their diabetes packs (meter, poker, strips, juice, extra batteries, extra lancets, and fruit roll ups) every where they go. My dd who is now 12 frequently complains about the profile of her pump (although I believe Animas has the lowest profile). She wants her skinny t’s and her skinny jeans to be seamless – not possible with a pump attached thus wearing the Dexcom (which we purchased and has collected dust for 2 years) is not a happy thought for her.
Well this has been a babbling mess. Thanks for baring with me as I learn how to blog effectively.