Big Blue and Bowie - in bed together forever

UPDATED August 27, 2017 (see Note 1)

So, if you haven't read my blog post about Big Blue, my Animas Vibe's first week of use, then hop on over to this LINK.  The rest of what I write about below will make more sense.  I'll try to keep this short and sweet since hey, it's TGIF!   Let the weekend begin!!!

After posting the blog on my disappointment with the accuracy of Big Blue who has CGM capability (this sounds like the Six Million Dollar man ... we have the technology ) along with a few other quirks.  Here's my update.

I cannot return the Vibe.  Plain and simple according to the Animas representative that came by after my blog went around the globe.   Due to the ADP program in Ontario, you cannot just pick and choose a pump, then decide it's not to your taste.   A wee bit disappointed with that, but the rep made things abit easier with the following suggestions that I will have to live with for the next 5+ years, or until Big Blue bites the dust.

The reps suggestion?  While I still have a functioning Ping aka Ziggy.  When I want to wear something slinky that I can't access my insulin pump in order to bolus, etc.  Simply use Ziggy along side Stardust my One Touch blood meter with Bowie my Dexcom receiver.  Simply remove insulin cartridge from Big Blue - plop it into Ziggy.  Best of both worlds as the rep put it!

We also came to the decision that due to incorrect sensor placement on arm, that this was the reason for the Vibe CGM and Dexcom receiver being off that I wrote in my previous blog.  I can agree on that after removing the sensor due to the fact that it was not sticking well on my arm and sensor wire looking not too straight. We think it was barely in my skin.  Plus, I had placed the sensor incorrectly, since the muscles in my arm when it's placed HORIZONTALLY, tends to pull the wire back/forth, cause sensor tape to not stick as well.

Silly me, deciding to try the horizontal placement for a change of pace, thinking well, if it works great on my "flat" stomach, why not the arm too?  NOPE!  Muscle, muscle, muscle ... pull ... pull ... pull. The rep of course reminded me that we are not supposed to place our sensor anywhere else but our stomach, and basically just pretends he doesn't know that many of us do things with our medical devices that are not approved of in the manual.

So, after placing a new sensor in ... correctly ... this is where I found both the Vibe and the Dexcom receiver were spot on with each other.  Cancel that FAIL quote from the previous blog!

So, I am now only using my Vibe for seeing my trend (when you press the Contrast button, you can see the last CGM screen viewed).  I tend to to like to see the current blood sugar, that shows which way the arrows are going, along with the IOB (Insulin-On-Board).  Bowie, takes care of all my other needs for info on my blood sugar trend, etc.

NOTE 1:  August 27, 2017 - since writing this blog - I have decided to no longer use Bowie - since often I lose him  ... urrrhhh.  I've gotten used to relying on the vibrations/alarm set up on the Vibe ... though I may eventually go back to Bowie ... since again ... the alarms on the receiver are easier to determine if it's a LOW/HIGH .

Handy Trend Arrow Chart from Animas representative

The trend, and other information that is shown on Bowie aka the Dexcom receiver.  It is far is better for viewing than the Vibe pump screen. Also, when it comes to alarms, as stated in previous blog, hands down for Bowie who sings like a Hero in my eyes to save me from either going too low or too high.

Remember use me as an example .... don't rush in too fast for something until you do your research, which I should have done!  You might regret it!  DOH!!!

First week with Animas Vibe aka Big Blue

UPDATED August 27, 2017 (see Note 1)

I finally took advantage of the ADP program here in Ontario and now have been in possession of Big Blue .. aka an Animas VIBE and CGM System.  The program pays for all age groups of Type 1 diabetics in the province of Ontario for the pump and $2,500 a year towards pump supplies.  So, no more paying outright for my pump ... and making Visa travel reward miles on the purchase - boo! hoo! The pump warranty is for 5 years rather than the 4, when I would purchase my pump privately, so win win.  So until the pump breaks down, it's my buddy until it's death date of ... get this ... 2040!!!  Unlike my previous pump, a ONE TOUCH Ping aka Ziggy Stardust ... his death date IS December 31, 2022.  I'm still keeping Ziggy, as a back up for holiday until then.  He served me well!  I just wanted to have the pump and CGM integration that the VIBE offers.

------

A few people have written to me privately, asking me what I think of the Vibe, and after a week of using it, here's my honest thoughts.  I'll keep this as easy to understand as possible.  If it doesn't make sense, comment below and I'll do my best to answer you.

Comparison of Ziggy and Big Blue

PROS:

• The pump is a little bit bigger then the ONE TOUCH PING, so the screen is abit larger.  Probably due to housing more hardware inside due to the CGM being incorporated into it.  See below in CONS.    NOTE 1: After meet up with Animas rep - there is NO size difference - both the way (even they were fooled by the way the picture turned out).
• When it comes to entering the TOTAL that is shown on your screen when doing an EzCarb or EzBg.  You no longer have to scroll the numbers from 0.  If your TOTAL is showing 3.0 units ... as soon as you touch the OK and the UP BUTTON ... you are at 3.0 instantly.  It is still taking me time to remember this ... since you can rapidly go up to 6.0 in a nanosecond.
• You have your CGM display available to you.  See below in CONS.
• You can use any blood meter you want to - which in my case when I was using the 2020 - was FreeStyle Lite which uses the smallest droplet of blood and according to research has better accuracy of many other meters on the market (plus the strips are less expensive - a big factor for me come September when I no longer have work coverage).

CONS or as I call it FAIL:

• I'm finding the screen keys abit less soft, so you do have to press abit harder.  For someone with arthritis (which I have), it could be problematic in time.  Also, I wonder if the plastic on the buttons is more hardier, since the 2020 and PING seemed to wear down faster.  I never had these problems, but have heard from others who did.  Again, warranty for most people should cover this problem if it occurs.
• For the CGM ALARM settings -  they suck compare to the DEXCOM Receiver!  You only have options similar to what you use on your insulin pump portion for ALARM settings.  It's annoying as all hell when you're driving, and it's going off on some hissy fit.  Hard to distinguish one from the other.   FAIL!!!
• Accuracy between the DEXCOM receiver and the VIBE are not as accurate as I thought.  I had started them both off within 5 seconds of each other when booting them off so that Calibration times would coordinate.  The DEXCOM receiver wins hands down.  FAIL!
• You cannot set the REMINDER time on the PING for HYPO any lower than 30 minutes.  The receiver you can enter in as low as 15.  Not good in my opinion.  This also surprised my CDE's when they witnessed me experiencing a 2.8 while in their office (and I amazed them further by acting the same way ... cool and under control ... actually I was sweating like a pig ... and sadly ... the alarms on the VIBE did not forewarn me of my rapid decline in blood sugar like my DEXCOM receiver does.  FAIL!
• Too many screens to go though to get to the CGM area.  DEXCOM receiver wins hands down.
• No ability on the VIBE to enter in Activity or additional Insulin perhaps given by IM for high blood sugar (a no no still in my endo and CDE's eyes ... I swear I have whip marks on my behind from them!!!).  DEXCOM receiver - wins hands down.
• I am now limited to wearing separates again when it comes to being a Fashionista, no remote for pump entry for blood sugars, and also if you rely on pump soley for CGM reading ... you get it ... I dare you to look at this naughty picture!!

My lust for the ANIMAS Vibe was bigger than my brain!     

CONCLUSION:

If you are with the ONE TOUCH PING ... stick with it.  The only thing that got me into going onto the VIBE was the representative wiggling a carrot in my face at the yearly Insulin Pump meeting in March that all ADP participants have to attend ...  that for only $800 I could get a box of sensors, transmitter, and receiver IF I purchased the VIBE soon (Animas Canada is no longer going to be selling Dexcom supplies as of this summer, so they're getting rid of all their G4 stock).  As many of you know,  I live on handouts of expired sensors, receivers (and I even have a transmitter that may still have life in it from someone who went onto a G5 system) due to paying out of pocket.  Here I was with lust in my eyes for this great deal (as bad as I am when I see a deal in a thrift shop, but this is a life saving article that isn't $2!!).

A week later .... this is how I feel ... blah ... and wishing maybe I'd just stuck with good old Ziggy and his  side kick Stardust (the ONE TOUCH blood meter)  who sucks up alot of blood, but means I don't have to pull my pump out all the time to bolus, look at CGM reading.  Really fun when you're wearing a dress I'm telling you, make sure you are wearing clean, unholey underwear!!) - and if you didn't click on the "naughty" picture in the CONS area ... scroll back up - I double dare you!!

Sigh - I should really be more serious when I write shouldn't I?  Chin up and all that stuff.

Anyhow, I've turned off the CGM on my Big Blue, gone back to the DEXCOM receiver, that I've had for almost 4 years that is still working strong.  I had hoped with the VIBE that I would not have to use it, but I guess I was spoiled by using the receiver, and it works, it notifies me when it's unhappy with me.  Perhaps if I was a newbie to the CGM system on the pump, and had nothing to compare it to, then I'd not be writing this.  I wouldn't know any better.

In hindsight, I should have just waited it out until the end of my ONE TOUCH PING life when perhaps updates could have been made on the programming of the VIBE.  I'm going to contact both my CDE and Animas (they'll be getting a link to this blog) next week to see what we can do.  I'll keep you posted in upcoming blogs on my progress and I hope it's good news.

By Manny Hernandez - 2008 - Hope: Diabetes Supplies Art 

My first endo visit in over 30 years!

I had my first meeting with an endocrinologist who works with insulin pump patients last month.  In the past I’ve used either my GP or a doctor that works in the endocrine area of the health field, but does not hold the title after their name (just like me, at times I’m like a CDE, but in reality, I’m just someone with 50 years of experience with T1D).  None of my past care givers understood pump technology, so as I’ve mentioned in the past, I do my own tweaking, and had been doing fine until menopause hit me last year.

The last time I’d seen an endocrinologist was way back in the 80’s … and I rarely saw them due to being busy with life, and in those days, we didn’t have all the technology today, so in some ways, at least for me, diabetes was just something in my life that today now seems to encompass my every waking moment with machines that read your blood sugars (CGM), or control the amount of insulin that goes into your body (insulin pump), along with blood glucose (BG) meters, and different types of insulin. 

It was an interesting meet up with the, originally they were coming to where I live (an hour and a half drive for them), but then a week before I was told they would have their head contained in a screen (my words – not the CDE’s words) … think of Max Headroom if you are of my age group you will know.  So, with the CDE in the meeting … we got started on figuring out my control of my diabetes, that I’ve basically been doing by myself the past 30 years.

I’d downloaded all my pump/CGM/BG meter info to Diasend that morning from home, so while the endo asked me questions, the CDE punched numbers on her screen while listening.   The endo couldn’t quite understand why I wanted a lower A1c which puzzled me, as I thought she would encourage me to attain a better number.  Explaining how many of us want to avoid complications, etc. with keeping a lower A1c didn’t interest her.

Their main concern was the hypoglycemic (hypo) reactions I have been having at night lately that they saw with the Diasend report.  Which is understandable after learning from various conferences I’ve attended over the year, hypos are harder on a diabetic body then a hyperglycemic (hyper) – e.g. going up high.  Of course, it all depends on how high you go up, but to me, anything over 15 / 270 freaks me out and the methods I use to bring even higher ones down she did not approve of.  I’m also still very lucky, I wake up to hypos, CGM or not, and generally do not over treat them which is what many diabetics do which results in that crazy roller swing.  I’ve learned over the years, depending on the BG number, to go from 5-15 grams of fast acting carbs, wait 15 minutes, retest.   Helps to offset that crazy high in the morning when you wake up.

The endo asked me to set my CGM alarm during sleep time to 15 / 270 in order to have a solid sleep (as we all know – lack of sleep can affect our blood sugars not just our sanity in our work place the next day or relationship that for me is already compromised by menopausal mood swings!).   Of course, freak out, I did request permission from CDE a week later after tying to follow endo’s instructions so I am now able to correct anything over that number, “safety first” as the CDE told me.  They just want me to be more sparse about it and only anything over 10 / 180 – which I have been doing – but this is way against the way I’ve handled my diabetes over the years by myself.  They are hoping to see what happens with my BG without correction, does it go up and stay up, or does basal bring it down.

I started to realise around that point that I had an endo that sticks to the rules and no matter what I said (e.g. I asked her if I could go on metformin, which has been shown to help T1D teenagers in attaining more level blood sugars … and that a study was being done with adult T1D’s using the drug and showing great success).  No, unless I was using over 50 units of insulin a day, she would not consider it.  I felt like I had the door slammed in my face at that point.

 My promise to follow a snack plan (carb/protein) in the evening as the endo requested in order to avoid hypos overnight – nope - that didn't last long.  Though I have now gotten into soaking almonds in water, and having about a ¼ of a cup before bed time and BG’s seem to be great overnight.  I really don’t do snacks at night time, which is something I did as a kid at home when my parents followed the CDA/ADA meal plan.

So, overall, I am realizing that it is the CDE team that is the most knowledgeable in diabetes management.  I have yet to tell them that I’ve gone ahead with upping my basal (the high wake up blood sugars during some of my major hot flash periods that last longer since I had the hysterectomy a few months ago was too much for my control level of diabetes).

It’ll be interesting to see how things go for my next visit at the end of January.  I do have a friend in Ottawa (he is on the study with Metformin) who has told me his GP who follows his diabetes is taking on new patients.  It’s something to think about, and with how I’ve always taken care of my diabetes, where I only go to see a doctor when I need a new prescription or have blood work done to see how I’m doing … I may just go back to that routine. 

Main thing for me, it’s an interesting experience to have a CDE team after all these years of my time with diabetes and even better is that they understand much of today's technology unlike my former doctors and I don't quite feel alone in working in the coal mine of my diabetes control.

.