21 June, 2012

CGM studios presents....New Robot Parts!

I love tracking packages - it is one of my favorite things about Christmas time....I get to watch all the things I've ordered make their way around the country to my doorstep.  If you ever want to ship me something, send me the tracking information and it'll likely make me more excited than whatever is inside the box.  In this case I was pretty darn excited about what was inside too.

So a few weeks ago, I went to my endocrinologist and we discussed some new options in my diabetes management.  My A1c was 7.0, which was higher than every other time with the exception of my first appointment after my diagnosis.  For those of you who aren't lucky enough to get this test done every 3 months or so, it is a test of your average glucose levels over the past 2-3 months.  An A1c of 7 means that my average glucose levels over the past few months were around 154 according to the lovely wikipedia.  Fasting glucose levels for you normal humans should be under 110, and 2-hrs after a meal should be under 140.

There were many contributing factors to me losing some control over my diabetes management in the past few months.  My doctor attributes some of it to the "honeymoon" phase of my diabetes being over - meaning my body is likely not making any of its own insulin anymore, making it much harder to manage and much more unpredictable.  I was also under a lot of stress at work and in my personal life, and was having trouble not giving in to stress eating when I was surrounded by people who were.  Anyway - an option that we discussed for regaining control, especially since I've had a lot of difficulty lately maintaining normal levels during exercise, was a continuous glucose monitor.

It took a week or two to get all the insurance stuff sorted out - but finally I got what I wanted....A FedEx tracking number! (Seriously, you could get me just the tracking number for my birthday and I'd be happy).

I had a slight panic on the day that it was delivered because I  received a notice that it was delivered....and left on my doorstep.  The notation was that no signature was required.  This made me concerned for a number of reasons - quite a few dollars worth of medical devices/supplies were inside.  Packages are normally dropped off at the leasing office when nobody is home, not left on the doorstep.  To make maters worse, I had to drive to Rockville to get my fingerprints done for my new job and couldn't go straight home. Luckily, when I did finally arrive back at my place, this was waiting for me:

Opening it up felt a little like Christmas morning....the excitement of a new gadget.  So at this point I had received e-mails from a clinical specialist from the company that makes the continuous glucose monitor (CGM - aka my new frienemy) asking me what training options I would prefer.  I could do the self-training using the cd or the online tutorials, I could do training over the phone after viewing the tutorials, or I could wait and set up an appointment to do training at my doctor's office.  If you know me even a tiny bit, you know there was no way I was waiting to try this thing out.  If you know me, you also know that I watched every minute of every tutorial before I even decided that I wanted one.  If you REALLY know me, then you know that when I say I watched every minute, I actually mean I listened to it in the background and half paid attention while doing ten other things.  

So back to Christmas morning and opening the box (which soon became a Christmas present for the cats) - I hadn't even made it completely through the front door before I started pulling off the packing tape.  And inside was another box, and another box, and another box....it was like a set of nesting dolls, but in box form (ok, so maybe it wasn't that extreme.....).  Here is what was inside:

There were three of these boxes.  And inside each of these boxes were four sensors, and inside each sensor there were five golden rings.  There was also an additional box that had instruction books (mine is still in the plastic weeks later - to preserve its freshness of course), cables, power cords, the receiver, etc.  I pulled out all the parts that I needed and plopped myself down in front of my computer.  

Here I'm holding up the package with a new sensor and the device for inserting it.  In the background you can see the tutorial up.  Despite watching it and taking meticulous notes the first time (never would anybody refer to the notes I take as meticulous - and it would have been impossible to take notes while playing sudoku on my phone), I felt it would be best to play the tutorial again while I went through the steps of getting my CGM all hooked up for the first time.  

Here I've taken the backing off the tape on the sensor and applied it to my skin.  I paused before actually inserting it to take this picture - I mean come on, who doesn't want a photo album of their first days with their new robot parts?  So the next steps are to remove the safety thingamajig, push down on the plunger, pull up on the ring, and then you are one millionth of the way there (easy as 1, 2, 3.....).  

So here is where all those (1,000,000 - 3) other steps come in.  You remove the insertion device (this was the most difficult/awkward part for me the first time), snap in the grey transmitter, snap it in with the extra hangy tab thingy, and then remove that by twisting it away from your body.  So at this point I was pretty pumped - I got the damn thing in there.  Now came the worst part.....wait three hours before it actually does anything.  I have patience for a lot of things, but waiting to play with a new toy is not one of them.  

So here I am with everything attached - pump on the left side of the picture, and cgm and cgm receiver on the right.  After a day I decided I couldn't take the bulkiness of that carrying case for the receiver and ditched it.  

Here is the operation with just the two sites - pump on the left side of the picture and cgm on the right.  Cyborg status complete.  

So the first night I wore this, the alarms went off and woke me up 9 times - 3 overnight lows, with additional alarms because I was dropping quickly right before each.  This was a little scary because it had likely been happening for awhile and had been going unnoticed.  I made some changes to my insulin rates and things have been ok, but as I said above, this new little device is more of a frienemy than anything else.  I like having the extra security of knowing alarms will go off if I'm too high or too low, and I like that it tells me when my glucose levels are rising or falling quickly.  What I don't like is that I tend to overcorrect  - as soon as I see those dots heading for the top line I start giving myself insulin.  Which would be fine - except that when it doesn't come down right away I tend to get frustrated and give myself more.  And then more.  And then I end up low.  So sometimes I end up with this rollercoaster looking trend graphs.  I'm hoping this is just a newbie tendency and I'll grow out of it.  

Graphs like this are much happier - everything is between the lines, and the arrow shows that I'm holding pretty stable.  

So, every ten days I go through the steps above....lather, rinse, repeat.  I'm on my third sensor now and was able to put it in without watching the tutorial again, which was pretty sweet.  Almost like losing your training wheels.  

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