Thursday, June 28, 2018

Disconnected - switching to Omnipod

I'm reluctant to write another post with a positive review, since the day after I raved about my Libre I put in a new one and had a day of completely whacked out readings. The universe has a funny way of doing stuff like that. So I won't say that my switch over to the Omnipod has gone well.


I first started on a pump when I was 9 years old, and have been on one ever since. That's 17 years on a Medtronic. Needless to say, this was a big change for me. The adjustment has been interesting. I still find myself reaching for my waistband when I want to bolus. I catch myself guarding my waist when I walk through doorways or change my clothes. But after the initial disorientation, I've found myself feeling pretty liberated. Right now I have the pod on the back of my arm, and I feel like I can dance around and there's nothing attached to me.

For those of you who are unfamiliar with the system, there's two major parts to it. The pod, which is the insulin pump itself. The pod carries the insulin inside of it and sticks to your skin like a pump site would. It's changed every other/every two days. Then there's the PDM, which controls the pod through a wireless connection. The PDM doesn't have to be near the pod for you to get your basal. It just needs to be within communicating distance when you bolus. This is nice because when I go for a short run, I can set up my temp basal and leave my PDM at home. Or at work, I can leave it in my lunch bag and don't need to carry it around the hospital with me.

The Switch

My first step in switching to the pod was to call the company (Insulet). I explained that I wanted to try out the pod, and they sent me an empty sample pod. I wore this for a couple of days and decided to give the real one a shot. If you're currently using a competing company for pump therapy (i.e. Medtronic, TSlim), Insulet will send you a month's supply of pods with a PDM. If you don't like it, you can keep the PDM at no cost and keep using your old system. This was reassuring for me because it felt like such a big change to dive into without a safety net.

Insulet has you complete a form so that they can verify coverage with your insurance company. This is another important thing to consider before making a switch. Luckily the pods were covered at the same percentage my Medtronic supplies were, and will end up being about the same cost out of pocket every three months.

What I Like

Less Supplies: Since the pods have their reservoir inside of them, its only them you have to worry about. This makes for easier packing, storing and traveling with supplies.
Insertion: I'm not sure if it's mental or what, but just sticking the pod on and pressing a button without ever having to see the needle or hear that loud click makes it seem like an easier and less painful insertion.
Freedom: As I mentioned before, the ability to dance around without worrying about something falling off your hip is just pretty exciting after 19 years on a tubed pump. Plus, the pods have gotten much smaller since they first came out. They may be more noticeable than a pump site, especially in the summertime, but for me it's worth the extra asks and looks.

Dash System

Something else exciting on the horizon is the recent FDA approval of the Dash system for the pod. This will include a slimmer PDM that will be able to communicate with the Contour Next test kit, made by Bayer. This was the system I was using with my Medtronic pump, which is nice because soon it will be compatible with my pod system. The Dash will also use Bluetooth technology for its connection with the pod, which seems to be a precursor to more advanced technology (smartphone apps, the works).

If you've been thinking about switching over to the pod, I've say give it a shot. Worst case scenario, you don't like it and go back to your old system without having to shell out any money. If you're on MDI, request a sample pod and see how you feel about wearing it for a couple of days.



Friday, June 15, 2018

From packing to poutine and everything in between - my Quebec City adventures

If you follow me on Instagram I'm sure you know that I recently got back from a 5-day, 4-night girls' trip to Quebec City. For anyone who's never been, I highly recommend it. The sights were beautiful, the food was amazing, and the shopping was seriously detrimental to my wallet. We stayed right near Place Royal, a quaint little square with a killer breakfast cafe. Everything in the city was walking distance for us. We also took a ten minute drive to Parc de la Chute-Montomorency, a local park where the stunning Montomorency Falls are located. They have zip-lining and cable cars, and the park itself is amazing just to explore on your own.
Place Royal
Montomorency Falls


What I packed

Whenever I travel, I am nutty about packing medical supplies. Being in Quebec 5 days, I was scheduled for one site change. In addition, I brought three extra pump sites and two extra reservoirs. I brought the remainder of my Fiasp vial along with one unopened bottle. The vial of test strips in my kit was full, and I packed an extra vial of these along with about 20 strips for my Libre reader which doubles as a meter. For lows I brought two bottles of juice, three gels and of course the emergency Swedish Fish I keep in my car. I had a backup meter, a backup pump, an extra pump battery, and all the necessary chargers.

Now this may sound like a lot of supplies to most people, but believe it or not I spent a solid amount of time preoccupied about my test strip supply. Would I have enough? What if I ran out? Could you buy Contour test strips at a pharmacy in Canada? I was frustrated that these worries plagued me while I was trying to enjoy myself. I ended up having more than enough supplies, and no emergency trips to Canadian pharmacies needed to be made.

What I ate

Being on vacation calls for indulging. These means a lot of guesswork when it comes to carb counting. Throw drinking into the mix, and it's easy to see why my sugars tend to run high when I'm away. During my trip my blood sugars were primarily in the 200s. I wasn't happy about this, but I also tend to be more cautious to avoid lows when I travel. We were doing a lot of walking, which made me more hesitant to bolus too much. This is something I hope to work on in the future, especially as I grow more comfortable with my sensor. It's been especially tough getting back to work and real life because as my blood sugars level out, I am having hypo symptoms in the 100s.

What I saw - and who saw me

The beautiful views in Quebec City are endless. Whether you climb to the upper part of the city to get a full view of the Chateau Frontenac and the city below, or wander along Quartier Petit Champlain to do some shopping on the colorful cobblestone streets, your eyes are in for a treat. We sat at the Port de Quebec and got a view of the upper part of the city from below, and climbed to the bottom of Montomorency Falls after ziplining over them.

Chateau Frontenac
Petit Champlain
Since I've started wearing my Libre, I've gotten more comfortable overall with my diabetes being "out" and people asking questions. While in QC I decided not to worry about hiding my pump or my Libre. This was partially because I wanted to embrace who I am as a diabetic, and partially a social experiment. Would as many people ask me what the heck was on my arm as I am used to in Jersey?
During our five day stay, I got two asks. One about my Libre, and one about my pump. Obviously I didn't spend enough time in Canada to do a thorough experiment with a random sample and all those things I learned about in stats class. My overall feeling was that people ask more often here. Are Canadian people less nosey? Anyone from the area please feel free to comment your thoughts below.

To sum up, Quebec City was a little slice of European-style heaven nestled within road tripping distance from NJ. I had a wonderful time and would absolutely go back. When it comes to type one and trips, I think it will be a continuous battle. You can't take a vacation from diabetes. But each experience helps me grow and learn how to travel better with type one. One thing I know for sure is that I will never stop exploring. Diabetes will just have to come along for the ride.

Sunday, June 3, 2018

My Libre Experience

By now I'm sure many of you have heard about or seen pictures of the Freestyle Libre system. For those of you who haven't, here's how it works:

The system has two parts: the sensor and the reader. The sensor is itty bitty and gets inserted into the back of your arm. It stays in for up to ten days. When you want to get data, you click on the reader and simply wave it over the sensor. It gives you your current BG, along with a graph of your previous readings for as long as you've been wearing it. The reader also tells you if you're trending rapidly up or down, slowly up or down, or running steady.

Unlike the Dex or Medtronic system, the sensor doesn't automatically give you your numbers - you have to wave it to get the data. This means there's no alert system if you're about to go low or if you're creeping up. The reader works through clothing, and it has a built in Freestyle meter as well.


Journey to Libre

I started my journey, of course, with insurance issues. When I first attempted to pick up the system at the pharmacy, they told me that insurance covered none of it. This was when it first came out in the US, in the beginning of 2018. It was also VERY difficult to locate a participating pharmacy that had it in stock. After a frustrating failed attempt, I spent a couple of months on the Enlite system, as it was covered by my new insurance. I did get some good data with this, but I went through too many inaccurate readings and failed insertions. My mind drifted back to the Libre. I decided to go through the company, and let them battle it out. They reached out to my endo to get a prescription, and went back and forth between her office, the pharmacy, and insurance. The system ended up being partially covered, and the out of pocket is less than the Enlite system for me.

Bringing the Libre home was super exciting - at this point I'd heard more and more about how convenient and accurate it was, and was itching to try it out. I was especially excited to use it while running. I've been on it now for about a month, and am thrilled so far. The readings are accurate, I'm pricking my finger less, and I feel like a spy from the future every time I wave the reader and get hours of data. Not to mention I have the system decked out in gear from Pimp My Diabetes and T1D Chick. There are certain aspects of the system that I can see some people being hesitant towards, depending on their situation. Below I've detailed my pros and cons.

PROS

Accuracy: My libre is almost always spot on. I trust it, which is a big deal for me. Small discrepancies tend to happen when I'm rising or dropping quickly, like with most CGMs. 

Size: You cannot beat it in the size department. The sensor itself is roughly the size of a quarter and flat. The reader is tiny as well, even in a case. Because it's so flat to your body, it's harder to rip out on accident. 

Duration: Sensor change is every 10 days. Enough said. 

Dual meter: The reader can also be used as a meter with Freestyle Precision Neo strips. These strips are super convenient too- they're wrapped individually in foil so you can fold them up flat. I use them for when I'm running, at work, or need to carry less bulk. Then I don't have to carry my usual meter as well. 

Cost: Even with the lower rate of insurance coverage, the out of pocket still ends up lower than the Enlite for me. The original market price of the system is lower than other sensors. 

Minimizes alert anxiety: If you feel your lows and highs and aren't reliant on the alerts on the Dex/Medtronic, this can be a good option for you. I tend to have alert anxiety, in which I get alerted that I'm dropping or rising and tend to over-correct.  The Libre eliminates this for me.

CONS

No alerts: If you don't feel your lows and highs, this system may not be ideal for you. While it's easy to scan and check your BG, you don't have the peace of mind that may come with the alert system.

Not technically "continuous": Because you have to scan the reader over the sensor, the system isn't technically considered a CGM. It isn't automatic - you have to put the little bit of effort into it.

Insurance: Because the system is so new, it's less likely to be covered by insurance. Or if it is, it may not be completely covered. I anticipate that as time goes by and more people use it, more insurance companies will offer more coverage.


Bottom Line

Bottom line is, if your insurance will cover it, I highly recommend trying it out. It's small, accurate and fun to use. My coworkers in the medical field are in awe of it. Plus, it's always fun to hear people guess what the heck is on your arm. So far I've gotten:
  • A penny (this guess was from a 3-year-old)
  • A radiation sensor
  • Miscellaneous crap stuck to my arm ("Hey, you've got something stuck there")
We'll see what guess comes next...