Pre-bolusing

Pre-bolusing.

Most of us know what that means (bolusing for a meal or snack 10-20 minutes before you begin eating) and why it should happen (to give the insulin a chance to start working, so that the insulin action more appropriately matches the timing of digestion), but few of us are really truly doing it as often as we should. It’s just not convenient so much of the time – we don’t always plan our lives around exactly what time we will eat. And in some cases, like at a restaurant, it can seem next to impossible to safely do.

My dad always pre-bolused me as a kid – I was on Regular insulin then, though, and that insulin could take 30-60 minutes to even START working.  More ‘modern’ insulins take around 10-15 minutes to begin working. I’ve become lazy about pre-bolusing in the past few years, I’ll admit it. Lazy to the point where I’ll finish a big meal before I even CONSIDER bolusing. By which point my blood sugar is already going up, sometimes rapidly.

As I believe I’ve mentioned before, I had to switch from my beloved Novolog – per what my insurance company wants – to Humalog. I’m not a fan of Humalog. I’m using a lot more insulin (my I:C ratio went from 1:10 to 1:7.3 (yes, with a t:slim you can be THAT specific), my correction factor went from 1:40 to 1:30 during most of the day and down to 1:25 during the mid-day, and my basals went from mostly being 1.2 units per hour up to between 1.5 and 1.75 units per hour)…and with a lot more insulin use I’ve seen issues with my weight (again) going up. I also have noticed that Humalog takes longer to start working and has a longer ‘tail’ or action time than Novolog did.

A few weeks ago I began downloading my D-devices to Diasend – which I’ll admit I’d been very lax in doing at all. I did not like what I saw at all. I was giving way too much insulin chasing highs after meals and my blood sugar average was not where I want it to be.

I started making changes and the biggest one I’ve started implementing in the past week is pre-bolusing. I can’t always pre-bolus (in the morning I need to get up and eat right away, because I don’t have 15 minutes to sit around and wait for my insulin to start working) but when I can pre-bolus, I am.

Look at my results/the change I’ve made, in just one week:

graphs

stats

Just by pre-bolusing I’m spending 14% more time in range (between 70 and 180 mg/dl) and because I’m not chasing highs after the fact (highs can cause insulin resistance, and then you need MORE insulin to get you back to your target than you may have needed if you’d just bolused appropriately to start with) I’ve decreased my average insulin usage per day by about 15%.

And bonus: I lost just shy of 1 lb this week, without trying at all (I know, big deal…haha).

How many of you, my readers, regularly pre-bolus for meals? Does it make a noticeable difference for you, the way it does for me? Also, for anyone out there with gastroparesis, how do you handle the entire idea of pre-bolusing during a flare-up? I have flare-ups pretty irregularly, but when I do, I cannot imagine pre-bolusing would at all be safe – my food can takeover 16 hours to digest (I won’t even tell you how I know this). I’m still unsure how to handle bolusing during a gastroparesis flare-up, despite being diagnosed over a year ago.

 

Seeing A New Endo

Most people know what it’s like to start seeing a new doctor – there is always that question of ‘will I like my new doctor?’ present in the back of your mind. When you have a chronic condition like diabetes, that is further exaggerated because in most cases doctors are important pieces of the overall equation.

I am comfortable making changes to my insulin dosing on my own, and I don’t need my doctor for that, nor do I need my doctor to tell me whether I am doing well or not – I can tell this on my own. However, I do rely on my doctor for my prescriptions and my access to the prescription devices that I use – and I don’t want a doctor who tells me ‘no’ when/if I want to try something new. I want to feel supported, while also feeling independent.

Those characteristics aren’t always so easy to find. So I was a bit apprehensive this morning as I set out to see my new endo – which I should have done MONTHS ago (but it kept getting put off, appointments got changed, etc).

I am thrilled to report that my fears were completely unfounded. My new endo is wonderful. She asked me about my history with diabetes, my history with my various pumps, how my ability to feel hypoglycemic events is (pretty nonexistant), recorded my pump settings, discussed my A1c (6.2%) with me, checked my feet for sensation, decided I didn’t need changes to my insulin rates at this time…She honestly spent at least 30 minutes with me, which was unexpected (how many doctors spend half an hour with one patient?!…very few) but welcome.

She set me up to see my favorite nurse/CDE in 4 months to do another A1c, my bloodwork, and to discuss pump options – since I will be due for a new pump in late August/early September when the warranty on my t:slim expires.

Whether I stay with t:slim or move to something else will be a post for the future…

When Suggestions Go Wrong

I am part of several ‘Pay it Forward’ groups on Facebook. This morning in one of them someone asked very nicely for Verio IQ strips for a friend’s daughter, who is a toddler. I don’t use that meter anymore, because it’s hella expensive, so I have no strips to even offer. However, in the attempt to be helpful I did point out that there are several meters out there that have strips that are MUCH MUCH MUCH more affordable.

Specifically I suggested the Relion Prime, TrueResult, and Freestyle Precision Neo. I have all three (in addition the Up&Up Premium meter from Target). I use them all.

I was told that those meters are so highly inaccurate it would be dangerous to suggest those be used for a toddler. I was made to feel like my suggestion was not only unwelcome, it was hazardous.

I’m tired of seeing these strong opinions in the DOC. I’m sick of seeing people who think ‘This didn’t work for me, so it must be bad for everyone!’ mantra that seems to pop up all over the place. I’m tired of seeing the judgmental comments that come from some individuals, whether they intend them to be so or not.

I was not suggesting anything that my experiences would lead me to believe is dangerous.

I use those above mentioned meters. I have an A1c below 6. My A1c hasn’t been above 6.1 in over 5 years. If those meters were SO inaccurate, when I began using them my A1c would have risen, right? I’d have had some lows that were so debilitating I’d need medical emergency help, right? Well, I’ve had neither. The meters work with the same accuracy as the big name-brand super-expensive total-ripoff OneTouch meters.

Many people in the DOC are so scared of ‘generics’ or ‘off brands’ that they’ve become rude and judgmental about the suggestion that others use them as a way of greatly cutting costs. To which I say: get over yourself. If others are using them with great results, you can’t put a blanket statement on those products that they are ‘dangerous’. And if you truly believe they are, take it up with the FDA.

Which reminds me – the ‘generic’ meters have to meet the SAME FDA QUALIFICATIONS as the brand-name meters…..

I guess I’m just frustrated in general with the often-seen mindset that the most expensive product is the best. That is how we are being taken advantage of by the pharmaceutical companies. That’s what they WANT us to think….

Now I think I’m rambling, so I’ll stop.

In a more positive spin: Merry Christmas! I hope your diabetes plays nicely with you today!

Novolog vs Humalog

We’ve all heard our doctors or insurance companies says it.

“Novolog and Humalog are essentially the same. While one may act a little bit faster than the other, or one may have a slightly longer tail than the other…they are essentially the same. No significant differences are seen, clinically.”

Bullshit.

I have used Novolog for years now and I love it. It works well for me. I know when it will start working. I know when it will stop working. I know what it will do to my blood sugar when it’s high.

However, I have an insurance company that insists that Humalog is preferred. I can get my Humalog prescription for a certain copay…which is HALF the amount of the copay if I wanted to continue to obtain Novolog.

Knowing that price difference I (begrudgingly) switched to Humalog. I had quite a nice stockpile of Novolog when I switched my prescription so for several months I was able to continue using Novolog. However, in the past month I’ve had to transition to Humalog.

All hell has broken loose.

I cannot get a firm grip on my basal rates, my ISF, or my I:C ratio. My average blood sugars have been far higher than I was used to on Novolog. The Humalog is unpredictable – one day it will begin working very fast after I bolus, the next day it will seem to take 30 minutes, and the next day it won’t seem to do a damn thing for about 4 hours…by which point I’ve given more insulin (probably a few correction boluses, actually) and then all of a sudden it seems that the insulin I gave 4 hours prior works….along with all the corrections after and I plummet from 400+ to low within an extremely short time-period. Overall it appears to have a longer tail……..usually. But sometimes it seems to have a much much much shorter tail.

I can’t figure it out.

I hate Humalog.

I’m using about 33-40% more Humalog than Novolog and I’m still not seeing results anywhere close to what I was able to obtain with Novolog.

‘Go back to Novolog!’ you say. Yes, simply said…expensively done.

What I really need is a nice long extended weekend to do some basal testing. But it’s the holiday season. I work a full time job and a part time job. One of my jobs is in retail. I don’t have nice long extended weekends.

If you have made the switch from Novolog to Humalog (or vice versa) and have had difficulty, please feel free to share your sage words of advice. If you made the switch easily and with no needs to adjust your doses…well, go away. Your diabetes plays too nicely!

A (Very Quick) Review of the Dexcom G5

This is going to be pretty concise, because there are many features (ex: anything having to do with a phone) that I cannot review. I am an avid Android user and there is no current Android app for use with the G5.

Pros of the G5:

  • Brighter/better colors on the screen: I was never a fan of the black background of the G4 system. I much prefer the brighter white background of the G5 system. Some people have conveyed that they are not fans because they feel it’s too bright, but I feel all the colors work better together/offer better contrast and with my weird vision issues due to my past retinopathy treatments, this is preferable for me.
  • When I am high or low and my Dexcom G5 alerts me it gives me more information RIGHT AWAY, than my G4 did. For example, on both systems my low threshold is set to 70. If I hit 65 on the G4 it would alarm but the screen (before hitting the button) would just tell me that I was below 70 – I couldn’t see what my actual level was until I acknowledged the alert. On the G5 it will actually tell me what my current BG is before I even acknowledge the alert by hitting the button. This isn’t a major thing, but it was noticeable, and I like it.
  • My G5 receiver feels sturdier than my G4 receiver. It feels just a little heavier, but more importantly the buttons all feel more…solid? I don’t know how I want to explain it, exactly, but on the G4 receiver the buttons always seems ‘loose’ and kind of…wobbly. Everything just feels higher quality on the G5. This could just be all in my imagination however – maybe it’s just a difference between ‘old, very well used receiver’ vs. ‘brand new receiver’ and has nothing to do with G4 vs G5.
  • The battery life of the receiver has been better than anticipated. The manual says 3 days of life on a full charge…but I went 3.5 days before I charged, and I still had about 33% remaining when I began charging.

Cons of the G5:

  • No Android app…..that’s literally my only current complaint.

It Shouldn’t Be This Hard, Part 2

A supervisor/manager called within an hour of my last blog post going live (what a coincidence….considering I linked to it on Facebook and Twitter and called them out publicly on Twitter…). He apologized and said they’d ship my order first thing in the morning, overnight shipping at their expense. This is great, but I was a bit horrified that he named off an address I haven’t lived at since June. I still have NO IDEA how they got that address – I NEVER gave Solara that address! Yet last Thursday the person I spoke with named off that address – I corrected her, letting her know we moved across the street…and that is my billing address. I gave a completely different shipping address for my parents’ house because they are retired and can receive expensive/valuable packages on my behalf while my husband and I are at work. However, the gentleman I spoke with tonight had no record of these addresses. I sincerely hope this isn’t the beginning of what I went through with Edgepark…where they’d ship things to long expired addresses that I had requested over and over and over and over they delete from their system…..

Anyway, my package did not ship yesterday morning. It did ship by late afternoon local time (mid-evening in my time-zone). It made it here overnight and was delivered to my parents’ house this morning. I’m not a fan of the fact that no signature was required, so UPS just left it outside on my parents’ porch. (When will medical supply companies learn to at least ASK if we’d like to have to sign for our EXPENSIVE packages???)

I had a brief moment of panic when I opened the box and saw only one transmitter. Dexcom has been pretty clear they are shipping all new G5 systems with TWO transmitters, because they time out after 3 months (with a short grace period of some additional days built in). I called back the manager at Solara and got his voicemail. I inquired whether I was supposed to receive only one, or I should have gotten two – and will I experience weird billing/authorization issues when I request another one in 90 days….since MOST people are receiving two right off the bat and will not need to reorder for 180 days…

After my brief panic I took a closer look at the individual boxes. That’s when I noticed something interesting….. their pharmacy people are complete morons, and now it’s confirmed! Yes, I have 3 refills on my transmitters…so that question is answered. However, instead of 11 refills on my sensors, I have 99. Yep, this year I could potentially (if I could afford it, which I most certainly CANNOT) obtain 100 boxes, in total, of sensors. Pretty sure that’s wrong…. And the thing that makes me mad? The prescriptions were registered in their pharmacy on October 14, 2015. That was 15 days ago. 15 days ago I was being told ‘We haven’t heard from your doctor’ and getting the run-around and being ignored. So….I was lied to by Solara, so that my prescription order could sit for almost 2 weeks without being processed.

ARE. YOU. F’ING. KIDDING. ME?!

I’m so over this, and I’ve only used them for one order. No one has bothered to mention to me if they have an autoship program, and if so am I on it. Since it was never mentioned and I certainly didn’t give permission to bill me for future orders, I’m going to use the next 30 days to try to find ANYONE else who may take my pharmacy benefits for Dexcom supplies and get my RXs transferred. This experience has put a very sour taste in my mouth. Diabetes is hard enough, without adding bad customer service, lies, and unnecessary waiting to the mix.

I’m going to call Byram tomorrow and see if they take my pharmacy benefits….they were AWESOME when I got my Dexcom G4 and subsequent supplies through my medical benefits with them. Not a single problem for almost a year and a half. I could easily reorder online and know my supplies would be delivered within 5 business days, to the correct address. The one time they needed to call my endo for a refill RX on the sensors they let me know why there was a delay. Love them…want to go back to them.

Knowing my luck, I’ll be stuck with Solara however. Cause that’s how things go for me….

It Shouldn’t Be This Hard

I’ve been trying to get a Dexcom G5. I never upgraded to the G4 with Share, and my G4 system went out of warranty in early May. I’ve been using my current system while ‘walking on eggshells’, but I wanted to wait for the G5 release. When Dexcom made their announcement I decided it was time to get a new system.

It’s been a horrible two months…and I still don’t have a G5. This story is so long and convoluted it would be funny except it’s too sad and infuriating to be funny.

My insurance policy states that they require preauthorization be obtained before a CGM can be purchased. So I called my insurance company’s ‘medical management’ and left a message. A day later no one had returned my call so I called again. I was told ‘you don’t obtain authorization…the DME provider does’.

My insurance is technically an EPO so I went with my ONE in network provider, our ‘in house’ (insert name of my employer here) DME provider. I called and requested information on how to start the process to order a Dexcom, via voicemail. The next day I got a call back from someone saying ‘We don’t handle that. Go through your local (insert name of my employer here) pharmacy.’

So I called the pharmacy and left a message. A day later I got a call back saying they have no idea what a Dexcom is and cannot obtain it for me.  So I called back the in-house DME provider and left another voicemail. A day later, I get a call back from someone referring me to someone else within their department. I call her and leave a voicemail. A day later I get a call back from her and am alerted that I will need to submit 90 days of BG logs to her. NOT a Dexcom report – they want my actual fingerstick results.

I use three meters (one kept at home, one kept in my purse, one kept in my desk at my full-time job) so I had to pull three meters and try to download to Diasend. Only one would download. So…I had to go through them each and log everything by hand. This took several days because it took HOURS of time. I emailed this out and then heard nothing for about a week. Called back and was told ‘We are obtaining preauthorization…but it can take up to two weeks’.

So a week later I called again and was told I’d received authorization and they’d act as go-between for me and Dexcom. Then Dexcom, being overwhelmed by orders, never got back to my ‘in house’ DME provider. Eventually I called again and requested pricing info in the interim and was told ‘we don’t actually have a contract in place with Dexcom…’ and the price quoted was SO FREAKING ASTRONOMICAL it was frightening. Like…5x the cash-pay price direct from Dexcom. So…I called Dexcom to confirm/deny this, because I couldn’t believe it. They could neither confirm nor deny in a timely manner, so I asked them a few days later about my pharmacy benefits. Three days passed with no word so I called again and was told ‘we don’t take your pharmacy benefits…but Solara Medical does.’

Then I called my ‘in-house’ DME provider, cancelled my order, and called Solara Medical. I left a message. No response. The next day I left a message. No response. The following week I left two messages. No responses. Finally I managed to reach a LIVING PERSON and she took my pharmacy benefit information. Four days passed with no answer, so I called back and left a voicemail. Someone called me the next day and told me my pharmacy benefits were acknowledged, my price would be $300 for the system, $100 per month thereafter for sensors, would I like to order? So I said yes, and they requested my doctor’s information. It took them three days to even fax paperwork to my doctor, and then another day to call me back after it was returned to them.

This was last Thursday and on that call I gave my credit card info to pay my $300 (which was immediately charged…they can do THAT quickly!) and I was told that I’d get a shipping confirmation and would have my G5 system in 5-7 business days. It’s now been 3 business days….I have received no shipping confirmation. I’ve left two more voicemails and I’ve emailed my ‘intake coordinator’ at Solara. No responses.

Really…it shouldn’t be this hard.

IT SHOULDN’T BE THIS HARD.

IT SHOULDN’T BE THIS HARD!

This is a product I REQUIRE. I don’t want it because I have some sick desire to continually stab myself with needles. I don’t want it because I enjoy wearing medical devices stuck to my skin…medical devices which cause me rashes and discomfort.

I need this because I CANNOT FEEL LOW BLOOD SUGARS. That, as you are well aware, is dangerous. This technology can essentially eliminate the danger.

Yet these companies act like patients…patients like me, patients in general…don’t matter. They take their sweet time doing seemingly nothing, dragging their feet, etc. They show extremely poor customer service, compassion, concern, etc, as if they are the only option in the world.

Let me tell you a little secret (which really isn’t a secret, if you’ve read my blog before): I’ve never been confined to an ‘only option’. I have been known to go ‘out of network’ to get supplies that I need, because my in network option(s) sucked so bad and provided such horrible service. I will happily quit my relationship with Solara before it ever really begins, if that is what I feel is best for me and my health. Period.

Here’s to hoping someone gets back to me tomorrow….