A weighty decision
When I was first diagnosed with diabetes, I took one insulin injection a day: a little bit of Regular and a little bit of NPH mixed in a syringe before breakfast. That quickly shifted to twice a day: before breakfast and before dinner.
I had a glucose test kit that stayed in the school nurse’s office. In 1981 (1st grade, diagnosis), it was a urine test, in 1991 (11th-12th grade) it was a blood test. But it was there, not with me.
The only thing I carried around with me everywhere I went was a little box of Sun-Maid raisins, in case I felt low. Or maybe a roll of Life Savers, which always ended up permanently stuck to the paper wrapping (and each other) ensuring I had plenty of fiber with my low BG treatment.
At some point I switched to blood tests, first by holding the strip up to a color chart, and later by using a big, clunky meter. I took it with me on family outings, but I don’t remember ever taking it to school. All I took was the box of stale raisins to treat lows; or maybe a roll of Life-Savers, inseparably stuck to the foil wrapping and each other.
I don’t ever remember carrying a meter with me in school. In 9th grade, I had a late lunch period and consistently went low during my biology lab period before. But I fought through it like a
champ chump, traveling light.
I can’t remember if I carried a meter with me to class in college. Twelve years later after diagnosis, I was still on just two injections a day, each was a mix of Regular and NPH, taken before breakfast and dinner, with the Regular dose on a sliding scale that increased with my blood sugar. The scale matched the intervals on the old Chemstrip color chart: 180-240, add 1 unit. 240-300, add 2 units. 300-400, add 3 units, and so on.
At some point, in the late ’90s, I started carrying a meter around with me. It’s also when I went from animal-sourced insulin to Humulin, and eventually Humalog replaced Humulin R. But on two shots a day, I didn’t usually need to carry insulin. If I did, I pre-filled the syringe, stored it in a hard plastic toothbrush travel container, and stuffed it in my pocket.
This is who I was growing up. Care-free, traveling light, and happy. (And not feeling particularly wonderful).
Not until 2004 did I go to true MDI, with Lantus before bed and Humalog before every meals. Now I had to test my blood sugar and carry insulin pens for use at lunchtime. So my pockets began to fill.
Three years after that, I started pumping. I carried around a pump and a meter, plus treatments for lows and contingencies for pump malfunctions.
Then came a CGM stuck to my body. (Though I have since traded in the stale raisins and paper-covered-candy treats for the surprisingly more palatable glucose tablets).
As a sign of the times, I also carry a cellphone.
As the years went by, I could easily make small additions to my travel portfolio, but its now bursting at the seams. I can’t take any more.
It’s enough. My pockets are full and my load has become heavy. There’s a fine line between the inanimate travel-companions being a benefit and being a burden, and right now, I’m right up against that line. Another lancet could push me over the edge.
My belief (coined by JDRF) of “Less Until None” weighed heavily in the decision of the next step in my diabetes treatment.
Migrating to a bigger CGM site and a separate receiver, in one regard, is a step backward. If I could get the sensor that communicates with the pump I already have to work reliably enough, to warn me of the lows and the highs, I’d be golden.
Fortunately, I’ve been able to spend a lot of time with the Enlite sensor and its big-brother 530G pump. It’s been a little over three months that I’ve been using it, and to be honest, I still haven’t mastered it. But I’m advancing.
Despite the message you may have
gotten from some of my previous posts, I don’t feel like I’m helplessly up against a wall. I’m still learning. And the folks at Medtronic have been incredibly gracious and patient in teaching me and allowing me to learn at my own pace.
Truthfully, I fully understand that the courtesy they’ve extended to me is not the same that they would offer to others who aren’t part of their “special trial” and who aren’t going to blog about it to the world (or, if not the world, then to the 12 or so people who regularly read this blog.) And believe me when I say I’m going to make a valiant effort to have them improve their communications – and if they can’t offer help that’s helpful, I’ll put myself out there and offer to do it myself.
Lately, I’ve had some very good experiences with Enlite. I’ve also had some very not-so-good experiences. But overall, the good are becoming more frequent, and I believe that, eventually, I’ll learn to master this quirky system. I believe it really can work.
It’s a quirky system which defies intuition, and it certainly could have been designed better. That’s a post for another day. And meticulously going through the steps to get the sensor properly “implanted” (that’s a strange word, isn’t it? but it’s what they use) sure is a cumbersome pain in the ass.
But it’s not as much of a pain as carrying around a separate device: one that doesn’t show boluses on the graph, doesn’t read my meter, and doesn’t report data with all my other devices. And doesn’t do a lot of other stuff that the 530G/Enlite system does, too.
Changing a sensor is something I’ll do once a week. Fumbling with an extra receiver is something I’d do 24/7. Weighing one inconvenience against the other is pretty clear.
So, after a long and arduous process, I’ve made my decision regarding the MiniMed system.
I’m keeping it.
Posted on July 23, 2014, in Continuous Glucose Monitor (CGM), Diabetes, Insulin pump and tagged 530g trial, Dexcom, enlite. Bookmark the permalink. 14 Comments.
I think of your raisins (I think you’ve mentioned them before, maybe in a comment on another blog ?) whenever I send my boy out with just his Dexcom and a packet of Skittles. (And his pump.) Whoo-wee living like a carefree 80’s T1d.
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I remember on another post saying that you should go with Medtronic if you want a “system” or use Dexcom if you want a better CGM. Hope it’s a good decision for you:-) Says she who is wearing cargo pants with a pump in one pocket, Dex receiver in another pocket, phone in another pocket, and glucose tabs, keys, and Fitbit in another….
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Your history sounds so much like mine that I nodded along the whole time I was reading it. I think I started true MDIs a year earlier than you, but began pumping a year later. The rest is pretty much the same though.
Congratulations Scott… I know actually making the decision is always hard, when you know you’re going to be wearing it for four years or more. Hope it’s everything you expect and more.
I remember my mom always carrying raisins for us (we’re both T1D). So many other kids didn’t like raisins and I couldn’t understand why lol.
Yay for picking Enlite! One of the reasons I started following your blog in the first place was because you were using Medtronic devices like me (when so many others I follow do not). I was a little sad thinking you might go over to the other side.
The separate receiver is what keeps me away from Dex as well. While I probably have it a little easier than you since it’s socially acceptable for me to carry a purse, I still have to fill it with a wallet, glucose tabs, meter, two cell phones (work and personal), and other odds and ends. I don’t want another device either. Plus, I like seeing my boluses and other info on my sensor graphs.
Those little bolus-ticks are so underappreciated. I use them constantly to see if I’ve given a correction-bolus enough time to work before thinking about another one.
Congrats on making that decision, Scott! Glad to hear you found a decision that’s best for you, and looking forward to hearing more. Thanks for participating in that trial-run and sharing your honest perspectives here for all of us to look to.
Also, I don’t understand how to use the ISIG information to my advantage. I think I understand what it is but can you explain at all?
The ISIG is a measure of the electrical current generated by the mixture of glucose and the magical goo that’s on the sensor. In a perfect world, your BG should be about 5 times the ISIG (I think the acceptable range is something like 3 to 8…I have it written on the back of an envelope somewhere), so an ISIG of 30 should be a BG (rather, SG=sensor glucose) of 150. With the SofSensor, a BG 130 would be an ISIG 15….but the Enlite has twice the sensing-power (or something like that), hence double the ISIG.
The ISIG is useful to me in determining (1) if my sensor is bad or if a previous bad calibration is leading to bad results , and (2) if my BG is stable enough to give it the initial calibration (though usually I just calibrate after the 2-hour warmup, and if things seem weird, I wait until its steady, then restart the sensor and calibrate again).
There’s a lot more I could write about ISIGs, but I hope this is a start! Oh, but one other thing…Dexcom keeps them a secret.
Your picture made me smile and I like your french doors.
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My 5 year old has been using Medtronic pump and sensors. Little tricky at first but when I got the hang of it and found some tips and tricks to make it easier it has been smooth sailing. I also refer to the isig a lot too. Since cgming his a1c had stayed between 6.7 and 7.1. Pretty good for a little kid. I also have the Mysentry which make nights so much easier for me. I don’t test him at all during the night unless too high or too low. I have it set to alarm when he goes to high or low. Then I get up and treat as needed. Good luck to you.
We gave our due diligence to both Medtronic’s CGM and the G4 for our girl. She has the 523 Revel and we love it. We went with the Dexcom after looking at studies and figured we’d really love it when it would Bluetooth to an iPhone instead of the receiver. Imagine a fit kid who just can’t seem to climb over the 100 lb mark, (Ketone attacks) wearing skinny jeans, a pump, infusion set, Dexcom transmitter and receiver, and a cell phone. Hmmmm. Well, we still went with Dex anyway because the cell phone will be permanently affixed to her fingers for, like, you know…forever (Jimmy Fallon awknerd teenaged girl voiceover here) and the cloud thing will be an incredible bonus. Once the receiver is a thing of the past, we’re golden. Still haven’t jumped on the bandwagon of #wearenotwaiting. Apparently we are waiting.
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