Category Archives: Continuous Glucose Monitor (CGM)

I have no recollection of that bolus, Senator

I woke up low yesterday morning.

Which, ordinarily, is no big deal. It happens. I’ve been pretty aggressive with my pre-dawn basal rates, actually trying to program a Super Bolus into my regular basal pattern (jack up my basal rate really high one hour, then cut it down to almost zero for the next) so I wouldn’t need to play those games every day at breakfast.  That hasn’t been working too well, but that’s not why I woke up low.

This is why I woke up low.

BolusHistory

Apparently, for reasons I can’t remember, I decided to give myself a shit-ton worth of insulin at 3:25 in the morning. Without entering a BG. Without entering carbs. Just straight, unjustifiable Novolog.

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The Big Chill

Ironically, the low-point of my CGM graph makes it look like a big smile *

Ironically, the low-point of my CGM graph makes it look like a big smile *

I am guilty of a scary borderline-serious low this evening.

I say borderline-serious because I was still fully aware of what was happening around me, and because I never reached that confusing haze, also known as Telltale Sign Number One.

I say borderline-serious because my CGM was, at one point, showing a 54 mg/dl with double-down arrows.

I say scary because I felt fine – I had no idea I was so low (and going lower, with a full unit of insulin on-board from an earlier high correction). I would not have known if not for my CGM alert, and even then, I thought it was a false reading until my meter confirmed it.

Then the sweat caused my shirt to stick to my back, and my hand to constantly wipe my oversized (thanks, receding hairline) forehead. Then I really believed it.

Though I’ve been doing a really good job of keeping by blood sugars on the lower-but-normal side in the eight weeks or so leading up to Thanksgiving (I’m targeting a monumental A1c improvement), I’ve pretty much fallen off the wagon since Thanksgiving, so much to the point that I’m feeling lows when they aren’t really low, which has led me to trust my feelings more.

Sometimes, trusting one’s feelings is a good thing. When it comes to hypoglycemia awareness, it is not

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How to build a better Enlite

A little over a year ago, I wrote a post on How to build a better insulin pump, based on the Medtronic Revel. Since very little has changed from the Revel to the 530G, those wishes/recommendations still apply. But now that I’ve had some time to play around with Enlite, I’ve got some wishes/recommendations on how that can be improved upon as well. My reason for posting this is simple — if nobody knows, nothing will change; but if someone (or some-two, or some-many) makes noise, it’s more likely to be heard. With the goal of being taken seriously, I’m keeping my recommendations somewhat simple and realistic.

* * *

The new Enlite and Enlite “Serter” are a vast improvement over the predecessor. In nearly every way. That goes without saying.

When I first saw the Sofsensor, I concluded that this must have been designed in-house by Medtronic, and not by Unomedical, the Masters (and manufacturer)-of-all-things Infusion Set related (and whose website appears to be out-of-commission at the moment).  Medtronic’s first CGM lacked the characteristics of something being designed by the Masters.

Enter Enlite. It’s better, and it took into account all the feedback received from Sofsensor users. It, too, has been designed in-house. And  sadly, it too lacks some of the characteristics of something designed by the Masters.

Let me be clear: I do think the Enlite is a good product, and this in no way is meant to be criticism worthy of driving someone away from using it. My reason for writing it is so that Medtronic – or perhaps another manufacturer – can learn something and make improvements the next time around. My hope is that they’ll take a look at some of the “little things” that can leave a big impression. And maybe, just maybe, the current product can undergo minor improvements while still being the current product.

Allow me to explain.

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A weighty decision

Dx-on-dischargeWhen 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.

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I’m right, and everyone else is wrong?

ThreshSuspendSounds ridiculous, right?

I keep asking myself why I feel this way about the Enlite sensor.

I keep telling myself that – despite the experience of others – I can get it to work to my satisfaction. I want it to work, I really do. Really, really, really.

Lots of times, it does. When my diabetes is behaving well and my blood sugars stay in a comfortable range (say, between 70 and 200 mg/dl), Enlite’s performance is fantastic. Awesome. Impeccable. And I’m happy – very happy – and I tell myself that I’m going to stick with it after my trial (disclosure) is over.

But then something goes wrong.

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