Cleo 90 Sets

A few months ago I heard a lot of t:slim users talking about the Cleo 90 infusion sets, and I wanted to give them a try. When contacting Smiths Medical, the manufacturer, I was told that they do not give out any free samples – they recommended I buy a box.

Seeing as how I pay a 20% coinsurance and the contracted rates with my insurance are so high, that was an absurd answer to me, and I declined.

A nice gentleman in the t:slim users group on FB offered to mail me a few.  He mailed me three sets (6mm cannula, 42in tubing).  

I have since used two of those sets.  Here are my thoughts:

Pros:

• The connector is much smaller than some other sets. It seems to me it takes up less space on my skin and is a bit more ‘flat’ to the skin.
• While some people have spoken of skin issues/irritation with the adhesive (it’s different than that used with most other infusion sets), I haven’t had irritation or itching at all. My old standby, Insets, actually cause me more itching.
• The set can be connected to the cradle in any direction you want, so when you insert the set you don’t have to worry about what angle your tubing is sticking out at. This is great if you change where you stow your pump from day to day because you change the direction of your tubing and make sure things are right where you want them.
• The tubing seems to be made of a more flexible material than other tubing. It may be my imagination but it also seemed just a bit thinner.

Cons:

• My blood sugars seemed to spike significantly after about 30-36 hours with the set in. I can wear an Inset for 4+ days (I know, NOT recommended!) without BG issues. This may have to do with the set itself, or could just be that I was using 6mm cannulas and I have always used 9mm with every other set.
• Insertion isn’t fully ‘automated’ like with other sets. With other sets that come with an inserter you press down on some buttons of some kind and the spring-loaded injector plunges the needle in – you don’t control the speed. With this set YOU control the needle going in. It’s not a totally manual insert, but it’s definitely not like Insets or Quick-sets or Springs. I am not a fan of that – after 21 years, I DO still have some anxiety about sticking needles into myself.

While the set has a lot of pros, the cons outweigh them for me – especially the BG issues.  I have one more set left, and I’m sure I’ll use it. But I likely won’t actually order any sets with future supply orders.

Testing Should Be Mandatory….

A few days ago an ex-coworker of mine sent me a text to tell me that a former student of mine (who will forever be etched in my memory, he was QUITE the interesting student), had lost his little brother to a sudden death.  At the time I spoke with my ex-coworker the cause of death was not being announced. I asked her to pass my condolences on to the family and I haven’t given it a lot of thought since then.

Then tonight……I found a news article. I was shocked to find it was about this very family, and it hit close to home in another way as well.  

The child, just a toddler, died of undiagnosed type 1 diabetes.

The mother is pushing for blood sugar testing to become a mandatory part of regular pediatric visits for all children, so that other families don’t have to go through what their family is going through.

I whole-heartedly agree with her.  It would be so easy to prick a child’s finger and see what their blood sugar is.  How many lives could be saved? How many children could potentially avoid a frightening diagnosis involving DKA?

Why, when this testing is so inexpensive in the grand scheme of things, is it not done?

As parents or future parents, we in the DOC know the symptoms to look for – but many do not. This simple testing could help parents who may have no idea what the symptoms of Type 1 are and who are not actively looking for them.

What do you think?

2 Years

Today my blog is 2 years old. It definitely does not feel like it has been that long. Thank you to everyone who has read, commented, and continues to read. I always love to hear from those who read my blog and hope you will continue to share your thoughts, opinions, and experiences related to D.

Follow-Up

Many of you asked me to follow-up on my last post.

I don’t have the best news to share.

At the end of today’s lecture my professor clarified for the class that insulin does not cure diabetes…….but then went on to spew some crap that basically insinuated we’re all going to be blind amputees.

REALLY?!  AAAAHHHHHHHHH!!!!!!!

The sheer stupidity just astounds and overwhelms me.

My husband asked me if I’m going to contact the professor again.  I will not. I feel that if I do….he’ll just correct that statement and then say three more incorrect things.

Sometimes…you just can’t fix stupid.

(On a side note, in our lab sections I will happily be correcting anyone’s misconceptions this week, as it’s a smaller class and our TA encourages participation.)

Spreading Ignorance in Higher Education

I have not been so angry in a very long time.

I can’t even fully express how angry and sad I am.

My Anatomy and Physiology professor, someone who should by all means know better, went and spread some horribly ignorant information to a lecture hall of 330 people.

We have been studying the endocrine system. In his last lecture he discussed the pancreas and diseases related to malfunctions of the pancreas.  He differentiated between type 1 and type 2 and pointed out that type 1 is more rare.

But that’s about as far as his correct information went.

First of all, his lecture slides indicated that ‘some cases of Type 1 are caused by an autoimmune response’. Since when are just some cases autoimmune? Just about every single case of type 1 is autoimmune. The one and only exception that I know of is someone who’s had to have their pancreas removed due to trauma, and that’s very rare.

That didn’t make me too mad.  Maybe it was just me being picky over wording (I told myself). But then he went on.

He said that type 1 is cured by giving insulin.

CURED.

CURED.

Are you flipping kidding me? He actually used the word ‘cured’.

I was so flabbergasted I couldn’t even speak up to correct him in class. I was stunned. I was in shock. How in the heck can someone say insulin is a CURE?

I emailed him this afternoon. I explained how I’ve had Type 1 for 21 years, and if insulin was going to cure me, it wouldn’t take 21 years to happen. I explained how often Type 1 diabetics face so much ignorance about how we treat and manage diabetes; how people often think if we just eat better or exercise more we will be cured. I told him how I don’t want an entire lecture hall full of students who are going into the medical field to potentially think insulin is a CURE….because it isn’t.

I asked him to rescind his statement from today in his next lecture. I asked him to please clarify for the class that insulin is a TREATMENT, which is keeping people with Type 1 alive until a cure can be found.

I have received no response yet. If he doesn’t respond, I may spam my entire class via the email reflector we’re on and explain it.  I would never normally do something like that, but I can’t stand to know that there are probably some people in the class who don’t know anyone with Type 1 and who didn’t read the textbook (which does an excellent job of describing Type 1) and who took what our professor said at face value.

Seriously….we are in major trouble in terms of disseminating accurate information if those educating our future medical professionals can’t even get it right.

Pump Peelz

I recently ordered two items from Pump Peelz for my Verio IQ (and my backup Verio IQ).  Essentially they are pretty stickers, to liven things up a bit.

I love them! (And yes, after I took this photo I noticed the crinkly bit in the upper left corner of the lefthand meter – I smoothed that wrinkle out and it looks perfect now).

So pretty! It was hard to pick only 2 (but I only have 2 meters to put them on).

They are pricey for  what you get, but I decided to treat myself and dress up my D a little bit. We’ll call it a post-endo visit celebration.

Quick Sticks Review

About a month ago I bought a box of the Sour Apple flavored Quick Sticks at my local Walmart. I had been looking for them for a while and it was the first time I was able to actually find them.  I’ve been using them to correct lows lately and I really like them!  Here’s my assessment:

Pros: These are compact and fit in my wallet/purse/backpack/where ever very very easily. Also, I like that they are 10g of carbs.  I don’t follow the ‘Rule of 15′ (treat with 15g of carb, wait 15 minutes, retest) because 15g of carbs is often more than I need if I am at home or in class.  (The only time I need 15g or more is if I am at work, which is often physically demanding (at work I default to juice boxes for my lows)). I also appreciate that they are completely water-free, so they can’t freeze or get weird in cold weather (let me tell you….the jelly beans I left in my car over the winter got really bizarre and were hard to eat….).

Cons: The only con for me is the price point. I paid $4.98 for a box at Walmart, and that was marked as a ‘special’ or sale price.  I haven’t checked the price since I bought them, so I’m not sure if that truly was a sale price or if that is the everyday price.  However, this is far too expensive for me to use Quick Sticks as my long-term hypoglycemia solution.  I am on a really tight budget, and it makes a lot more fiscal sense for me to defer to other methods of correcting lows.  One box of Quick Sticks will correct 12 lows, for a cost of 41.5 cents per low BG….while I can buy Hi-C juice boxes and correct a low BG for 28 cents apiece.  Or I can buy Target’s brand of jelly beans and correct a low BG for about 8 cents!

Final assessment……..you should definitely try these. They are a great way to correct lows without OVERcorrecting, taste good, are a convenient size, etc.  The price is just too high for me (and, I suspect, for many in the DOC) to use them as the primary means of correcting lows.

Endo Visit

I saw my endo today.  He was just as puzzled as I am by my recent insulin resistance. He said he’s encouraged by the fact that I was able to get my rates and ratios to a point where I am back under control, but he’s stumped as to why in the course of a few days I could get to a point where I suddenly need 10-15 more units of insulin per day.

He ordered my regular bloodwork, but also is having a few other tests run to check some other hormone levels and see if something hormonal is ‘off’.  That includes my TSH levels, which up until now have been normal…but I do have a history of hypothyroidism in my family and I was exhibiting goiter a few years ago, which seemed to resolve itself shortly after.

My HbA1c is up a tiny bit from 5.5% to 5.6%, but that’s perfectly fine – my goal is to keep it under 6% for the rest of my life.  (It’s been under 6% since December of 2010!)

The best part? Being told I was his ‘poster child for great control’.  Just 5 years ago I was most likely his nightmare patient!

Advice For D-Moms and D-Dads

I was recently asked a fantastic question via a comment here on my blog, which I believe may have been posed to others in the DOC as well (at least, I know of others who have been planning similar blog topics).  What was posed to me was this:

I have a question for all you young adults with type 1. I am raising a son with type 1 that has had it since he was only 16 months old. He is 8 1/2 now and I am starting to figure out ways to hand over some responsibility to him. The problem I have is that I have never had a disease that is a 24hr a day annoying problem poking at me. I am asking you all what things your parents did that you did not agree with or just flat out annoyed you and even maybe made you angry about having the disease in the first place. I want to support him as much as possible and educate him on the risks without running the risk of making him retaliate in the future. I keep hear about teenagers getting fed up and stopping the care they need. I even met a man that found his son dead in his sleep only 3 years after diagnosis. Please, please, please share with me your thoughts on how I can maybe share this burden with my son without interfering too much. I really want to be able to send him off to college with a clean conscience but I need help from the other side of the fence.

I have been thinking about this for several days now. I don’t want to give an answer that isn’t complete, yet I also don’t want to point out every little tiny detail I liked or didn’t like about how my parents treated my D.  So here’s what I came up with:

The thing that annoyed me most that my parents did was to tell me ‘no’ in regards to certain foods.  Even when I was old enough that an explanation could have been given (“Your blood sugar is already high.  You shouldn’t have any ice cream now.  Maybe you can have some later”), none ever was.  I was told ‘no’ far too often.  While I was using a sliding scale of Regular and Lente, which varies greatly with many CWD now who use pumps or more easy-to-adjust MDI/carb-counting regimens, I never understood the ‘no’s and I was often angry. I acted out by sneaking foods that I knew darn well I shouldn’t be eating. When my blood sugar would later be sky high I’d deny knowing anything about how it happened.

So, my advice: If a ‘no’ is warranted because for some reason a bolus for something just isn’t in the cards, at least explain to your child why you are denying them of something. Don’t let them feel confused by the denial for what they want.  Be as accommodating as you can of their request, and then explain to them why you said yes or no.  Help them understand how that food choice is going to affect their blood sugar in the near future. Discuss how they might feel if they eat something that might send them into a really high blood sugar and help them brainstorm other options. If they want whatever that food is, help them understand how to make that choice in a smart way – maybe by pre-bolusing a bit more, if appropriate. Or maybe by getting some extra exercise afterwards. Help your child see the whole picture – not just the yes or no.

This is where a lot of my own issues with rebelling come from – my parents didn’t take the time to explain things to me. If I requested something and was denied, I didn’t have any other explanation than ‘because I’m diabetic’. This led to a lot of bitterness and a lack of knowledge on how best to care for myself. When I moved out on my own I was excited that I could then start to make all my own choices in terms of how I was going to handle things…but I was ill prepared.  I didn’t fully understand how my choices were going to affect me.  I hadn’t had those things explained to me, and it took me a long time to figure them out on my own. In the meantime I was in and out of DKA.  Had my parents better explained how foods, exercise, bolus timing, etc. were going to affect me I would have been better able to cope.

(Please don’t get me wrong – I’m not angry at my parents.  They did what they felt was best, and I know they felt very overwhelmed by my D at times. However, their methods are not how I’d raise a child with D.)

So I guess it all boils down to communication. Communicate with your child about D. Explain things to him or her. Don’t just answer their questions – ASK them if they have questions. ENGAGE THEM. And let them know you think D is just as unfair as they think it is.

WTFructose: An Ongoing Tale of Utter Confusion

I have no idea what is going on with me lately, but I am suddenly extremely insulin resistant.

Extremely. Insulin. Resistant.

It’s like pumping water.

The thing is – it’s only happening during part of the day.  I am fine when I get up in the morning. Fine through breakfast and lunch.  Then around 3pm….something happens.  My body turns against itself (or against my insulin) and all hell breaks lose.

Two weeks ago I was averaging BGs of 124, pumping a TDD of about 37 units.  In the past week I’ve gotten to the point where I am averaging a BG of 204, pumping a TDD of 60+ units.

Seriously….wtfructose?

It’s literally the name of my current profile on my t:slim….

I’ve taken my basals from about 1u/hr to 1.5u/hr.  I’ve taken my ISF from 1:40 to 1:35.  I’ve taken my I:C from 1:10 to 1:8.  On top of that, I’m correcting with many many many units of insulin every night.

Nothing is working.

The fact that my BGs are good during the first part of the day makes it hard for me to believe it’s an insulin, infusion set, or cartridge issue (though I’ve changed all of them, just in case….to no avail).

It’s not dawn phenomenon….cause, well, I wake up long before 3pm.

It’s not a female hormone thing, and even if it were it would not go on this long and this extreme.

I don’t feel stressed (actually this started during my spring break – I was pretty relaxed!).

I do not feel sick.

I do not feel like I am experiencing allergies.

I cannot figure this thing out and it frustrates the heck out of me.  I see my endocrinologist on Tuesday, and maybe he can help – but I also feel badly that I’m going to go to him and say ‘Here, look! I’ve had HORRIBLE control this past few weeks – but I was fine before that, honestly, I was!’

What scares me most is that this could cause my retinopathy to act up majorly.  And a major flare-up is the last thing I need.

So, until I see my endo….I’ll just be puzzled.  And I’ll keep increasing those ratios and rates in the hopes of taming this monster we call diabetes.