Holiday's are rough for diabetics, especially kids. Most type 1 diabetics are diagnosed fairly young and have to start dealing with some tough choices fairly early in life.
Doctors and parents are telling them they can be just like everyone else, but they fight with the fact that they aren't really.
When I was growing up there were no at home blood glucose tests or insulin pumps there were no plans for fast acting insulin with each meal. You took one shot in the morning of an insulin that peaked several times throughout the day and designed a diet to eat when the insulin was peaking. At home Urine tests were supposed to tell you how you were doing. If you spilled too much sugar in your Urine you needed to eat less or take more insulin. It was a very inexact science.
This also meant that kids were not allowed any real sweets at all. Candy, Cake, Ice Cream, that was called cheating. I cheated a lot. I stopped doing Urine tests after about a year and without any way of really seeing what the food was doing to me ate a lot of the wrong things.
Mom and Dad tried to help. On Halloween they would buy my candy from me. Whatever I brought home we'd have a little auction and I would get paid to give up my haul. Of course money doesn't taste as good as that Three Musketeers or Reeses your sister is eating so I would find the stash and sneak it anyway. As I got a little older I learned that I didn't have to go find the stash, I just had to hold some of it back.
Halloween is still a hard time for me. So much chocolate sitting around the house and you think "oh one won't hurt that much." I end up using a lot more insulin this time of year. This will actually be my first Holiday Season with the Continuous Glucose Monitor. I'm anxious to see how that will change things
In today's world of carb counting, CGM's, insulin pumps and more exact dosing, I wonder what parents are doing to help their kids get through a Holiday where the main goal for everybody else is to see how much candy you can grab and eat.
My Life, Diabetic. Thoughts on the technology I've used, the struggles I've had and what it is to live this life with broken Beta Cells.
Friday, October 31, 2014
Wednesday, October 29, 2014
Thoughts on the Tandem T:Slim pump, A follow up.
After a couple more weeks of using the T:Slim and some more research I wanted to do a follow up. I will say up front that I still regret my decision to give in to United Healthcare and switch from the OmniPod which was working for me so well but I wanted to pass along additional information on this new pump that I'm wearing.
Again none of what I'm writing here is supported by research and I don't have any real explanation for some of it. It is only one users experience with the pump.
Fist off I'd like to give what I understand is Tandem's explanation for the seemingly disappearing insulin. According to my research Tandem's explanation is that they are being truthful with their customer's while other pump manufacturers are hiding the fact that insulin disappears. They say that no pump can deliver all of the insulin that is loaded into it. Other manufacturers hide this by having the syringes used to draw up the insulin modified to match their pump. You don't notice the insulin that is missing as you draw it up because it appears you are drawing up 200 units of insulin when you may be drawing up 220. Tandem claims that the syringe they give for drawing up the insulin is marked correctly and in an emergency could be used to manually bolus. After loading the cartridge the pump lists the usable insulin and you notice the missing units. I'm trying to figure out a way to test this. I think I have a couple of Medtronic Syringes, when I end up with an empty insulin vial I may draw insulin into one syringe put it in the empty vial then draw it into the other to see if the units match.
I've also found that there is a metal tube at the bottom where the cartridge goes in that can get dirty and cause incorrect insulin level readings. One website I was reading said that Tandem recommended that they clean this metal piece with an alcohol swab at each cartridge change. I've started doing this and it seems to help some.
Another feature I've been reminded of with the T:Slim, that I forgot to mention in the first post was it's carb entering screen. It has a built in calculator. A nice feature if you're out to dinner and trying to count up your carbs. Instead of having to add the entre, potato, veggie, all in your head (yes we've all learned to do this over time) you can just put the carbs for you entre in on the screen hit the plus button then the carbs for your potato (or side) hit the plus button again and so on. The T:Slim adds up the carbs for you. Not a huge deal but it does make things a little easier.
Those two things being said I'm still unimpressed by this new pump my doctors office seemed to like so much:
Again none of what I'm writing here is supported by research and I don't have any real explanation for some of it. It is only one users experience with the pump.
Fist off I'd like to give what I understand is Tandem's explanation for the seemingly disappearing insulin. According to my research Tandem's explanation is that they are being truthful with their customer's while other pump manufacturers are hiding the fact that insulin disappears. They say that no pump can deliver all of the insulin that is loaded into it. Other manufacturers hide this by having the syringes used to draw up the insulin modified to match their pump. You don't notice the insulin that is missing as you draw it up because it appears you are drawing up 200 units of insulin when you may be drawing up 220. Tandem claims that the syringe they give for drawing up the insulin is marked correctly and in an emergency could be used to manually bolus. After loading the cartridge the pump lists the usable insulin and you notice the missing units. I'm trying to figure out a way to test this. I think I have a couple of Medtronic Syringes, when I end up with an empty insulin vial I may draw insulin into one syringe put it in the empty vial then draw it into the other to see if the units match.
I've also found that there is a metal tube at the bottom where the cartridge goes in that can get dirty and cause incorrect insulin level readings. One website I was reading said that Tandem recommended that they clean this metal piece with an alcohol swab at each cartridge change. I've started doing this and it seems to help some.
Another feature I've been reminded of with the T:Slim, that I forgot to mention in the first post was it's carb entering screen. It has a built in calculator. A nice feature if you're out to dinner and trying to count up your carbs. Instead of having to add the entre, potato, veggie, all in your head (yes we've all learned to do this over time) you can just put the carbs for you entre in on the screen hit the plus button then the carbs for your potato (or side) hit the plus button again and so on. The T:Slim adds up the carbs for you. Not a huge deal but it does make things a little easier.
Those two things being said I'm still unimpressed by this new pump my doctors office seemed to like so much:
- Cartridge change and site change take a lot longer than any pump I've used in the past. This morning at least 15 minutes if not 20. This was from beginning to end. removing old infusion set, drawing up insulin, filling cartridge, filling tubing of new infusion set, inserting new infusion set, priming the cannula.
- No easy way to change Cartridge on the go. If I wanted to change the OmniPod at lunch at work rather than in the morning I took a vial of insulin and a new Pod with me. That's all I needed and the actual change took about 7 minutes. My Medtronic was even simpler. I took an infusion set and a pre-filled reservoir. In order to change the T:Slim you need: A cartridge, A syringe and needle, (these are not packaged together) an infusion set, a vial of insulin. You cannot pre-fill the syringe and you cannot pre-fill the cartridge.
- I'm using more insulin and getting less result. Since I've begun using the T:Slim I have noticed higher spikes after eating and a much slower response in blood sugars coming back down. This was so drastic at dinner and in the evening that I changed the carb ratio at dinner to 1:5 from 1:6 and increased my overnight basil rates. Even with these changes I continue to see overnight rises in blood sugar that did not occur while using the OmniPod. I'm not sure if insulin delivery, site choice, infusion set could cause this but I definitely notice a difference.
- After being spoiled by a tubeless pump I'm finding I really dislike fighting with tubing. So many things change with the tubing and a pump that's not water proof. I move a lot when I sleep. If I clip the pump to my shorts I end up rolling over it on my back and it wakes me up. If I let the pump lay beside me I end up tangled in tubing and waking up. I slept a lot better with the tubeless pump. Showers are a pain again. I hadn't thought about the way I used to do breakfast. I'd test my blood sugar and start a bolus. I usually wait till the bolus is delivered and give a couple of extra minutes before eating. I've found my BG spikes less this way. While the bolus was delivering I'd jump in the shower. I can't do this anymore because the T:Slim is not waterproof.
Monday, October 27, 2014
Wondering about Steak and Potato's
If you are diabetic and check this out or if you're a nutritionists I'd love to hear what you think.
I've gotten pretty good at estimating carbs when I go out to dinner and counting carbs at home. I went out to The Spaghetti Factory last night, ordered a chicken/pasta dish. I ate the chicken, sausage and some of the sauce along with a bit of the noodles. I left half the noodles on the plate and stayed away from the bread and was quite happily surprised at the way my blood sugar handled it.
Where I have been having trouble lately is Steak and Potato's. My youngest daughter learned to make twice baked potato's and she's been making them at least once a week. I looked up estimated carb counts for them and have been bolusing accordingly. The last two times we've had them though my blood sugar has skyrocketed in the late evening after I fall asleep. Again the Dexcom CGM helps because I can see the BS mainly flat until after midnight then start to rise, spiking around 2am and then staying at that level.
Is the steak fatty enough or do you think there is enough fat in the S/C and butter of the twice baked potato that I need to extend the bolus? My diabetic educator told me to do this with pizza. The fat in the cheese slows the absorption of the carbs so you extend the insulin delivery of the bolus taking half of it an hour or even two later. Otherwise all those carbs hit after your insulin is mostly gone. I'm getting better at doing this with pizza, I just didn't expect it to happen with Steak.
What do you think? Ever experienced this?
I've gotten pretty good at estimating carbs when I go out to dinner and counting carbs at home. I went out to The Spaghetti Factory last night, ordered a chicken/pasta dish. I ate the chicken, sausage and some of the sauce along with a bit of the noodles. I left half the noodles on the plate and stayed away from the bread and was quite happily surprised at the way my blood sugar handled it.
Where I have been having trouble lately is Steak and Potato's. My youngest daughter learned to make twice baked potato's and she's been making them at least once a week. I looked up estimated carb counts for them and have been bolusing accordingly. The last two times we've had them though my blood sugar has skyrocketed in the late evening after I fall asleep. Again the Dexcom CGM helps because I can see the BS mainly flat until after midnight then start to rise, spiking around 2am and then staying at that level.
Is the steak fatty enough or do you think there is enough fat in the S/C and butter of the twice baked potato that I need to extend the bolus? My diabetic educator told me to do this with pizza. The fat in the cheese slows the absorption of the carbs so you extend the insulin delivery of the bolus taking half of it an hour or even two later. Otherwise all those carbs hit after your insulin is mostly gone. I'm getting better at doing this with pizza, I just didn't expect it to happen with Steak.
What do you think? Ever experienced this?
Wednesday, October 22, 2014
The Biggest Game Changer out there
Last Spring it was suggested that I start using the DexCom Continuous Blood Glucose Monitor. I really believe this is the biggest game-changer I've ever experienced in controlling my diabetes.
I had struggled with the idea of using a CGM (Continuous Glucose Monitor) for a long time. I had hoped that a device like this would mean that I could go without regular finger sticks and testing. This does not do that and I figured why bother with another thing attached to my side if I still have to test my blood. I didn't understand all the benefits of being able to see what your blood sugar is doing at all times.
Couple of things, There currently is no spring loaded or easy inserter for Dexcom's sensors. You have to actually push a plunger in that inserts the needle which the canula for the sensor is on. You take the needle back out leaving just a tiny and thin canula. I've never gotten really good at giving myself shots always doing it slowly and carefully rather than a quick jab so this is no fun for me. I put up with it though so that I can get all the info the sensor provides. Also the CGM is not actually testing blood sugar. As I understand it there is a formula for estimating blood sugar based on the sugars in the fluid present in the upper layers of fat cells under the skin. This estimation is why you need to do finger sticks to calibrate the unit and to be aware that the unit may be off by as much as 20 points. I've found it is within 5 points most of the time and is the furthest off when my blood sugar is at the most extreme either high or low. Each time you change the sensor site you wait two hours while the unit compiles all that time of readings setting a base. At the end of two hours the unit buzzes or beeps, depending on how you have it set, and asks for two blood sugar readings. After inputting those two blood sugar readings the Dexcom takes a glucose measurement every five minutes and creates a graph along with displaying the most recent reading. It also displays an arrow to show which way you are trending Flat, slight incline or decline, straight up or straight down, double arrows straight up or straight down. (I've never actually experienced double arrows straight down) These indications of trend have helped me more than I could ever have imagined.
You can find most of the technical information on DexCom's Website . I'd like to give you an idea how the CGM has helped me, how I use it and why I hope I never have to live without it.
When I first got the Dexcom I couldn't believe how far my blood sugar swung back and forth after meals and with exercise. For everything that we had done and all the experimenting with bolus's and basil rates it just seemed that nothing made things right. I am still amazed sometimes by what I see my body doing that doesn't make any sense.
The first place the Dexcom started helping was with low blood sugars. Over 30 years of Diabetic life have caused me to really fear Low Blood Sugars. I've had some pretty bad episodes and hypoglycemic unawareness has caused me to really not feel it until my blood sugar is close to 40. I had a tendency to feel a low blood sugar episode and eat until I felt better. This normally caused me to swing wildly the other direction where I would take insulin to fix and #1 I set it to warn me when my blood sugar hit 70. I usually feel completely normal at this time but now I know early that something needs to be fixed. I get an earlier start on stabilizing. Also the trend arrow has helped. I know how quickly the low is falling. I can react to it based on that I eat and react differently to 66 and flat than I do 66 and an arrow pointing downward. This has helped me avoid the extreme lows while reacting with confidence in a way that also avoids the spikes afterward.
Learning to use the Dexcom to treat Low Blood Sugar has also taught me exactly how much I need to eat to change my blood sugar. Imagine trying to use finger sticks to figure out how many blood sugar points a single carbohydrate affects. When I treat a low blood sugar I'm able to watch and see how high blood sugar goes before it starts leveling out. A little math and I know that a single carb raises my blood sugar 5 to 6 points.
I should mention that it is not recommended by my doctor or by Dexcom that you use the readings on the Dexcom to treat low blood sugar. They have been very helpful to me and I don't always do a finger stick but remember that it has been my experience that the biggest change for the CGM to be off is at the extreme ends of the spectrum. Also it takes a little more time for the glucose levels to change in the fat and skin than in the blood so that may be a little behind. I will check at these times and find the Dexcom off. Be aware of that. Interesting note though. Because the Dexcom asks for two blood sugars to calibrate. I have tested on both hands to do the calibration before and my left and right hands have been as many as 20 points different. Who knows how real any of the readings we are getting.
The second thing the Dexcom has helped with is overnight blood sugar. #1 that thing buzzes when my blood sugar hits 70, no more waking up with cold sweats unable to think or see and feeling like I need to eat an entire quart of ice cream. "Buzz, Buzz" it's 70, get up, eat half a granola bar, go back to sleep. It'll wake me up again if that didn't work. #2 I had a huge problem with what my doctor calls "Dawn Effect" The idea that your own liver dumps sugar into you blood stream in the morning hours to help you body wake up. I was constantly waking up with blood sugars of 240 - 260. We couldn't add too much basil overnight because of the risk of low blood sugars in the early to mid evening. Being able to look at the graphs and trends from Glucose Measurements every 5 minutes allowed my Doctor and I too see exactly where the spike started happening on a fairly regular basis. We adjusted the basil rate to take this into account and my blood sugars on most nights, (unless I have too much for dinner), hang around 120 to 100 all night long. I think this may have been the biggest factor in lowering my A1c's.
Exercise is another place the Dexcom is invaluable. I have a huge lawn, I used to never be able to mow the whole thing without my blood sugar crashing and starting the whole roller coaster. Even with reducing my basil rate it was a problem. With the Dexcom I can watch the arrow. As soon as I begin trending downward, I take a little break, have a drink and a granola bar. relax for a minute then go back to the lawn. I'm able to check the Dexcom occasionally as I finish to make sure the food I ate was enough and adjust accordingly. I don't end up ruining my whole day after crashing my blood sugar and I don't end up eating so much that I'm in the 200's for the rest of the day.
Finally the Dexcom has made me feel like I stand a chance in controlling this disease. From being able to see what is happening I'm beginning to understand how different foods affect me and when they affect me. I've been surprised at how long it takes some food to begin to change my blood sugar. I've also been amazed at how long it actually takes before you begin to see a correction bolus bring blood sugar down. All of this information has affected the way I take insulin, the way I change my basil when I exercise, what I eat and how I eat. Does it work? In January of 2014 my A1C was 8.3 in August it was 6.2
Needless to say I love the idea of CGM and I think it should be standard for every type 1 diabetic. Doctors should be prescribing it and Insurance companies should be forced to cover it as cheaply as possible for any diabetic. It would save so much money in other things.
Couple of things, There currently is no spring loaded or easy inserter for Dexcom's sensors. You have to actually push a plunger in that inserts the needle which the canula for the sensor is on. You take the needle back out leaving just a tiny and thin canula. I've never gotten really good at giving myself shots always doing it slowly and carefully rather than a quick jab so this is no fun for me. I put up with it though so that I can get all the info the sensor provides. Also the CGM is not actually testing blood sugar. As I understand it there is a formula for estimating blood sugar based on the sugars in the fluid present in the upper layers of fat cells under the skin. This estimation is why you need to do finger sticks to calibrate the unit and to be aware that the unit may be off by as much as 20 points. I've found it is within 5 points most of the time and is the furthest off when my blood sugar is at the most extreme either high or low. Each time you change the sensor site you wait two hours while the unit compiles all that time of readings setting a base. At the end of two hours the unit buzzes or beeps, depending on how you have it set, and asks for two blood sugar readings. After inputting those two blood sugar readings the Dexcom takes a glucose measurement every five minutes and creates a graph along with displaying the most recent reading. It also displays an arrow to show which way you are trending Flat, slight incline or decline, straight up or straight down, double arrows straight up or straight down. (I've never actually experienced double arrows straight down) These indications of trend have helped me more than I could ever have imagined.
You can find most of the technical information on DexCom's Website . I'd like to give you an idea how the CGM has helped me, how I use it and why I hope I never have to live without it.
When I first got the Dexcom I couldn't believe how far my blood sugar swung back and forth after meals and with exercise. For everything that we had done and all the experimenting with bolus's and basil rates it just seemed that nothing made things right. I am still amazed sometimes by what I see my body doing that doesn't make any sense.
The first place the Dexcom started helping was with low blood sugars. Over 30 years of Diabetic life have caused me to really fear Low Blood Sugars. I've had some pretty bad episodes and hypoglycemic unawareness has caused me to really not feel it until my blood sugar is close to 40. I had a tendency to feel a low blood sugar episode and eat until I felt better. This normally caused me to swing wildly the other direction where I would take insulin to fix and #1 I set it to warn me when my blood sugar hit 70. I usually feel completely normal at this time but now I know early that something needs to be fixed. I get an earlier start on stabilizing. Also the trend arrow has helped. I know how quickly the low is falling. I can react to it based on that I eat and react differently to 66 and flat than I do 66 and an arrow pointing downward. This has helped me avoid the extreme lows while reacting with confidence in a way that also avoids the spikes afterward.
Learning to use the Dexcom to treat Low Blood Sugar has also taught me exactly how much I need to eat to change my blood sugar. Imagine trying to use finger sticks to figure out how many blood sugar points a single carbohydrate affects. When I treat a low blood sugar I'm able to watch and see how high blood sugar goes before it starts leveling out. A little math and I know that a single carb raises my blood sugar 5 to 6 points.
I should mention that it is not recommended by my doctor or by Dexcom that you use the readings on the Dexcom to treat low blood sugar. They have been very helpful to me and I don't always do a finger stick but remember that it has been my experience that the biggest change for the CGM to be off is at the extreme ends of the spectrum. Also it takes a little more time for the glucose levels to change in the fat and skin than in the blood so that may be a little behind. I will check at these times and find the Dexcom off. Be aware of that. Interesting note though. Because the Dexcom asks for two blood sugars to calibrate. I have tested on both hands to do the calibration before and my left and right hands have been as many as 20 points different. Who knows how real any of the readings we are getting.
The second thing the Dexcom has helped with is overnight blood sugar. #1 that thing buzzes when my blood sugar hits 70, no more waking up with cold sweats unable to think or see and feeling like I need to eat an entire quart of ice cream. "Buzz, Buzz" it's 70, get up, eat half a granola bar, go back to sleep. It'll wake me up again if that didn't work. #2 I had a huge problem with what my doctor calls "Dawn Effect" The idea that your own liver dumps sugar into you blood stream in the morning hours to help you body wake up. I was constantly waking up with blood sugars of 240 - 260. We couldn't add too much basil overnight because of the risk of low blood sugars in the early to mid evening. Being able to look at the graphs and trends from Glucose Measurements every 5 minutes allowed my Doctor and I too see exactly where the spike started happening on a fairly regular basis. We adjusted the basil rate to take this into account and my blood sugars on most nights, (unless I have too much for dinner), hang around 120 to 100 all night long. I think this may have been the biggest factor in lowering my A1c's.
Exercise is another place the Dexcom is invaluable. I have a huge lawn, I used to never be able to mow the whole thing without my blood sugar crashing and starting the whole roller coaster. Even with reducing my basil rate it was a problem. With the Dexcom I can watch the arrow. As soon as I begin trending downward, I take a little break, have a drink and a granola bar. relax for a minute then go back to the lawn. I'm able to check the Dexcom occasionally as I finish to make sure the food I ate was enough and adjust accordingly. I don't end up ruining my whole day after crashing my blood sugar and I don't end up eating so much that I'm in the 200's for the rest of the day.
Finally the Dexcom has made me feel like I stand a chance in controlling this disease. From being able to see what is happening I'm beginning to understand how different foods affect me and when they affect me. I've been surprised at how long it takes some food to begin to change my blood sugar. I've also been amazed at how long it actually takes before you begin to see a correction bolus bring blood sugar down. All of this information has affected the way I take insulin, the way I change my basil when I exercise, what I eat and how I eat. Does it work? In January of 2014 my A1C was 8.3 in August it was 6.2
Needless to say I love the idea of CGM and I think it should be standard for every type 1 diabetic. Doctors should be prescribing it and Insurance companies should be forced to cover it as cheaply as possible for any diabetic. It would save so much money in other things.
Monday, October 20, 2014
Affordable Care Act Debacle
Very soon I'm going to write about my favorite new piece of technology available to diabetics, the Dexcom continuous blood glucose monitor. Tonight though I can't sleep because of all the insurance problems that have been caused by the U.S. Government and I just want to rant for a moment about all the "help" this mess has been.
Being Diabetic since I was nine I have always been very careful to choose my employers based on whether they have a group health insurance benefit. I have not taken jobs and left jobs because of problems with insurance. My current employer offered one of the best plans I had ever had. I say offered because that is now past tense.
With the advent of the affordable healthcare act Blue Cross Blue Shield stopped offering our plan as a Government approved policy. It had a $500 deductable and 100 percent coverage after the deductable was met. It was a wonderful plan, but for some reason was not longer available under the Affordable Healthcare Act. Among the new choices from Blue Cross Blue Shield there were none that offered 100 percent coverage after the deductable. United Healthcare offered a plan though that had a $1000 deductable and 100 percent coverage and we were told the rest of the coverage was comparable to BCBS. My company switched to United Healthcare Mid year to avoid paying penalties. Since that time it has been one hassle after another getting insulin pump and other things taken care of.
My OmniPod pump that BCBS covered was an issue for United Healthcare so I switched to a pump I don't like. Getting sensors for the Dexcom is becoming tedious each time something that was not a problem with BCBS. Now I found that the mid year switch may be costing me another $800 because of confusion.
In late may I received a authorization from BCBS for pump supplies from OmniPod. The letter stated that the date of service had to be before June 15 because insurance would run out on June 15. I was confused because the policies were supposed to switch on June 1. I called OmniPod first to see where the order came from. They told me that I was on an auto refill program and they were going to send me new supplies every three months. I told them about the insurance change and they said that it appeared BCBS had already ok'd the purchase.
I called BCBS. I explained the situation and told them I wanted to stop the order if there was going to be a problem. She said that it looked like the insurance would be in place until the 15th and I should be fine as long as the order was before then. I confirmed this with her, telling her we were switching to UHC on June 1. She told me that the 15 day hold over was standard practice to make sure switching was smooth and there was no uncovered period. I let the order go ahead.
Today I received a letter from Blue Cross Blue Shield saying that the insulin pump supplies delivered on June 10 are uncovered because the policy was not in force at that time. I'm going to call them tomorrow but don't expect much luck. I also don't expect much luck with UHC in submitting this claim because they never wanted to pay for this pump anyway. So there's a $799 bill that's not covered sitting there for me all thanks to this wonderful Government act that took away my good insurance, saddled me with inferior coverage and has generally made life more difficult.
I'm so glad they are looking out for me in Washington.
Being Diabetic since I was nine I have always been very careful to choose my employers based on whether they have a group health insurance benefit. I have not taken jobs and left jobs because of problems with insurance. My current employer offered one of the best plans I had ever had. I say offered because that is now past tense.
With the advent of the affordable healthcare act Blue Cross Blue Shield stopped offering our plan as a Government approved policy. It had a $500 deductable and 100 percent coverage after the deductable was met. It was a wonderful plan, but for some reason was not longer available under the Affordable Healthcare Act. Among the new choices from Blue Cross Blue Shield there were none that offered 100 percent coverage after the deductable. United Healthcare offered a plan though that had a $1000 deductable and 100 percent coverage and we were told the rest of the coverage was comparable to BCBS. My company switched to United Healthcare Mid year to avoid paying penalties. Since that time it has been one hassle after another getting insulin pump and other things taken care of.
My OmniPod pump that BCBS covered was an issue for United Healthcare so I switched to a pump I don't like. Getting sensors for the Dexcom is becoming tedious each time something that was not a problem with BCBS. Now I found that the mid year switch may be costing me another $800 because of confusion.
In late may I received a authorization from BCBS for pump supplies from OmniPod. The letter stated that the date of service had to be before June 15 because insurance would run out on June 15. I was confused because the policies were supposed to switch on June 1. I called OmniPod first to see where the order came from. They told me that I was on an auto refill program and they were going to send me new supplies every three months. I told them about the insurance change and they said that it appeared BCBS had already ok'd the purchase.
I called BCBS. I explained the situation and told them I wanted to stop the order if there was going to be a problem. She said that it looked like the insurance would be in place until the 15th and I should be fine as long as the order was before then. I confirmed this with her, telling her we were switching to UHC on June 1. She told me that the 15 day hold over was standard practice to make sure switching was smooth and there was no uncovered period. I let the order go ahead.
Today I received a letter from Blue Cross Blue Shield saying that the insulin pump supplies delivered on June 10 are uncovered because the policy was not in force at that time. I'm going to call them tomorrow but don't expect much luck. I also don't expect much luck with UHC in submitting this claim because they never wanted to pay for this pump anyway. So there's a $799 bill that's not covered sitting there for me all thanks to this wonderful Government act that took away my good insurance, saddled me with inferior coverage and has generally made life more difficult.
I'm so glad they are looking out for me in Washington.
My early thoughts on the Tandem TSlim pump
On the advice of the diabetic educator at my doctors office I recently moved to Tandem's T:Slim pump. Admittedly I've only been using the T:Slim a month or so but so far I'm not a fan.
The T:Slim is small and takes up less room than the Medtronic I was using. The touch screen is nice, and I appreciate the ease of use but the amount of insulin that I loose in using the T:Slim is ridiculous. Let me try to explain.
Unlike other pumps I've used where you draw the insulin up and then attach the tubing and canula to the end of what you just drew the insulin into the T:slim uses a proprietary cartridge. In order to load the T:Slim you use a syringe to draw the insulin up and then fill the cartridge from the syringe. This is a multiple step process that is designed to do two things, I believe. #1 to keep the T:Slim, Slim #2 to keep air bubbles out of the tubing. If you fill the cartridge correctly there are a lot of safety features to reduce and eliminate air-bubbles. Filling the tubing though is a much longer process than the Medronic I used to use and I'm still trying to figure out where my insulin is going. As an example; last night I filled the T:Slim cartridge with 260 units of insulin. 17.5 units were used to fill the tubing another unit to prime the canula. So I should really have 240 or so units of insulin in the cartridge. After doing all this my T:Slim registered 185 usable units of insulin. Where did 55 units of insulin go? Some research says that Tandem builds a hidden portion of insulin into the pump just to make sure they are not overestimating. 55 units of insulin is almost another days insulin. This is expensive stuff.
The other problem I'm having is figuring out how much insulin I need to put into a cartridge to make it last three days. I was using 180 or so units every three days on my Optimod, Now I'm putting 250 units in and only getting 165 or 175 usable units. Since you can't add insulin to a cartridge once it's in use I've changed three cartridges now after only two days. I'm worried I'm going to run out cartridges before insurance is willing to pay for more.
That's my main problem with the T:Slim, the way it measures and uses insulin. I haven't figured it out yet. I did begin cheating and pulling the extra "hidden" insulin out of the used cartridge when I stop using it. One that said it was empty had almost 40 units in it another upwards of 20. This is not recommended by Tandem or by my doctor but I just can't waste that much insulin. So far re-using the old insulin in a new cartridge has not hurt my blood sugar. I am being very careful not to mix the insulin from the used cartridges back into the vial that is still relatively pure.
There is one thing the T:Slim does that I do really like and has already saved me twice. It's the bolus not finished alert. I have a bad habit of getting distracted and not finishing to the last button push a bolus at mealtime. Usually a few hours later I start feeling bad and look to my pump finding out that I didn't actually take any insulin at dinner and my blood sugar has skyrocketed. The T:Slim however will beep at you after 5 mins if you start to input a bolus and don't finish. I did it twice over the weekend and thanks to this smart little pump managed to keep my blood sugar fairly regular.
So the simple breakdown, from a person who has only used the T:Slim pump for a month now
T:Slim Advantages
Small
Built to avoid air-bubbles (I used to be really bad about air-bubbles)
Easy to use touch screen and controls
Insulin given by the hundredth of a unit instead of just a tenth,
INCOMPLETE BOLUS WARNING! (this is great)
T:Slim Disadvantage
It wastes a ridiculous amount of insulin
Takes far to long to change and load a catridge
There are too many pieces involved in changing and loading catridges.
Again if you have any thoughts or questions please feel free to comment.
Friday, October 17, 2014
Omni Pod pump .. My thoughts
I think I promised yesterday to give my Thoughts on the OmniPod. I loved it! I am so sorry that United Healthcare made it difficult to purchase replacement pods. I think I may have made a huge mistake switching back to a regular tubed pump in order to save the hassle of dealing with insurance.
First I have to say that United Healthcare hadn't out and out denied the Pods for the OmniPod pump but it did seem to me that they were going to require pre-authorization and doctors notes every time I ordered replacement pods. Every three months to go through all the effort put into authorizing a pump and wonder whether it would be approved. I unfortunately decided to go back to a tubed pump and am already regretting it. I will explain much of my regret when I tell you about the T-Slim pump tomorrow.
The OmniPod is a little different and has a bigger profile on you than most other pumps so you might have a problem with that. I didn't. Each OmniPod, Pod contains it's own tiny little insulin pump. This explains their expense. They are basically a 3 day one use insulin pump that attaches to your body. Each Pod is about the size of credit card and about 1/4 inch thick. I don't have one in front of me so I'm doing this from memory. This entire plastic piece is attached to your side, arm or leg, wherever your infusion site is. As you can tell this will be a bit more noticeable than the infusion site from other pumps. The wonderful thing about the Pod is that there are no tubes attached and running to a pump. everything, the circuit board, the memory, the insulin itself is self contained. This makes the Pod water proof and you never have to take it off.
When changing a Pod you keep it close to the wireless Pod Controller. and fill the Pod with insulin. the Pod Controller wirelessly uploads all the info for the pod to the onboard memory, Basil setup, Carb ratio etc. After the Pod is filled with insulin and things are ready to go you put the Pod on your selected site for infusion and push start on the pump controller. The Pod automatically inserts the canula and begins proper basil insulin delivery. From that point until the next Pod change you only need the controller to input info for Bolus's. You can shower, bath and swim with the pod on. I wore my Pod on my side and on the back of my arms on my triceps. There is so much scar tissue on my sides from years of pump use I found that absorption was much better while on my arm.
Advantages of the Pods:
First I have to say that United Healthcare hadn't out and out denied the Pods for the OmniPod pump but it did seem to me that they were going to require pre-authorization and doctors notes every time I ordered replacement pods. Every three months to go through all the effort put into authorizing a pump and wonder whether it would be approved. I unfortunately decided to go back to a tubed pump and am already regretting it. I will explain much of my regret when I tell you about the T-Slim pump tomorrow.
The OmniPod is a little different and has a bigger profile on you than most other pumps so you might have a problem with that. I didn't. Each OmniPod, Pod contains it's own tiny little insulin pump. This explains their expense. They are basically a 3 day one use insulin pump that attaches to your body. Each Pod is about the size of credit card and about 1/4 inch thick. I don't have one in front of me so I'm doing this from memory. This entire plastic piece is attached to your side, arm or leg, wherever your infusion site is. As you can tell this will be a bit more noticeable than the infusion site from other pumps. The wonderful thing about the Pod is that there are no tubes attached and running to a pump. everything, the circuit board, the memory, the insulin itself is self contained. This makes the Pod water proof and you never have to take it off.
When changing a Pod you keep it close to the wireless Pod Controller. and fill the Pod with insulin. the Pod Controller wirelessly uploads all the info for the pod to the onboard memory, Basil setup, Carb ratio etc. After the Pod is filled with insulin and things are ready to go you put the Pod on your selected site for infusion and push start on the pump controller. The Pod automatically inserts the canula and begins proper basil insulin delivery. From that point until the next Pod change you only need the controller to input info for Bolus's. You can shower, bath and swim with the pod on. I wore my Pod on my side and on the back of my arms on my triceps. There is so much scar tissue on my sides from years of pump use I found that absorption was much better while on my arm.
Advantages of the Pods:
- More variety of site placement: I can't imagine tubing running from my arm through my shirt and to a pump on my waist, but wearing a pod on my arm was easy.
- Waterproof: I wore my pods in the shower and even swimming. We went to the lake one weekend and I spent a few hours in the water each day. No problems.
- User less insulin: because you don't have to worry about filling tubing there is very little insulin waste. I was down to 175 units every three days. I'm putting over 200 units in my current pump and between the insulin lost in the tubing and the insulin it "hides in reserve" I'm getting only about 170 units of usable insulin.
- Never taking the pump off and not worrying about tubing kinks or air bubbles did seem to moderate my blood sugars much better.
Disadvantages of the Pods:
- They are much bigger on your body than traditional infusion sites. It can feel bulky occasionally. Felt huge the first time I wore it on my arm and I worried about the weight pulling it off. As I got used to it though I would forget it was there and bump it on things like door frames as I walked through. That's a little weird.
- There Pod only lasts three days. There is no extending the time if there is a little extra insulin there. It will shut down and force you to change the pod. This also means that if you change your Pod at 4 oclock in the afternoon you can't wait till a more convenient 6pm to change it when you get home from work next time. It will shut down at 4 and you will need to change it.
- Don't forget the Pod controller: I did twice and had to go back home and get it. You cannot bolus or do anything else without that controller. The Pod will continue giving you basil insulin and follow the proper pattern for that but if you want to change anything you need the controller.
- Controller's Glucose Monitor: OmniPod built a freeStyle Glucose monitor into the Pod Controller. Unfortunately my insurance didn't cover freestyle well and I ended up carrying a Glucose monitor too.
I Loved the OmniPod. I wish I would have fought a little harder to keep it. Now it seems I'm stuck with Tandem's T-Slim. The Diabetic educator at my Doctors office was really high on the T-Slim. So Far I'm not so impressed. I'll tell you why in the next post.
If you have any questions about the OmniPod please comment. I'll try to answer them.
Thursday, October 16, 2014
I finally decided to try and control it
I was diagnosed as a type 1 diabetic when I was nine years old. I guess that would have been in 1975. I never was very good at taking care of myself properly. My Dad was a doctor, My mom was a nurse so I didn't actually go to the doctor that often. You didn't need prescriptions for Insulin and syringes back then and there wasn't any way to test blood sugar at home. I followed the same regiment two shots a day, cheating on my diet and I'm sure swinging from wild high blood sugar to extreme low blood sugar everyday. Maybe as this Blog continues I'll tell some stories of almost killing myself through the years.
In the past 12 years I've been on several different insulin pumps and still had trouble taking the disease seriously. Last year I got the talking too from my Doctor. He said, "Your problem is that you don't feel sick, but if you continue the way you're going you are headed for nothing good." I had been running with A1c's between 8.3 and 8.7. Cholesteral was high and I wasn't trying really hard. Since that talk though I've begun really working to control this disease and I've already learned a lot about how things work and don't work for me.
I thought I'd share some of my journey some of my thoughts and some of my struggles. I've now used 4 different insulin pumps. Originally the MiniMed 500 series, Then Medtronic's paradigm 700 series. I used the OmniPod for a year or so until Insurance changed and made pods hard to purchase. Now I'm using the TSlim. In the next few days/weeks I think I'll take some time and explain thoughts and review each of the newer pumps.
I'm also using the Dexcom CGM. I love this technology and will tell you all about that too, if you want to follow me or continue reading.
The only complication I've experienced so far is Diabetic Retinopothy. This was scary and I still have a few floating reminders of blood leaking into my eye. I often wonder if those are new leaks or the same old stuff. I'll tell that story too someday.
I gess that's enough for a first post. Tomorrow the OmniPod, what I thought and why I wish I could continue to use it.
In the past 12 years I've been on several different insulin pumps and still had trouble taking the disease seriously. Last year I got the talking too from my Doctor. He said, "Your problem is that you don't feel sick, but if you continue the way you're going you are headed for nothing good." I had been running with A1c's between 8.3 and 8.7. Cholesteral was high and I wasn't trying really hard. Since that talk though I've begun really working to control this disease and I've already learned a lot about how things work and don't work for me.
I thought I'd share some of my journey some of my thoughts and some of my struggles. I've now used 4 different insulin pumps. Originally the MiniMed 500 series, Then Medtronic's paradigm 700 series. I used the OmniPod for a year or so until Insurance changed and made pods hard to purchase. Now I'm using the TSlim. In the next few days/weeks I think I'll take some time and explain thoughts and review each of the newer pumps.
I'm also using the Dexcom CGM. I love this technology and will tell you all about that too, if you want to follow me or continue reading.
The only complication I've experienced so far is Diabetic Retinopothy. This was scary and I still have a few floating reminders of blood leaking into my eye. I often wonder if those are new leaks or the same old stuff. I'll tell that story too someday.
I gess that's enough for a first post. Tomorrow the OmniPod, what I thought and why I wish I could continue to use it.
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