DexCom G4 Platinum: Follow Up

It's been three months since I first gave my impressions of the new DexCom G4 Platinum CGM and two months since I published a Second Look piece. Today it's time for a follow up...

Overall I am quite pleased to say that everything that I previously reported to you about the G4 still stands as true. Signal distance is vastly improved, insertion is less of an issue from a pain standpoint and accuracy is often spot on. What then you ask prompted me to write a follow up? I wanted to share my experience with DexCom customer service and how they handled my call to tell them that the thumb pad on Arden's receiver was breaking.

Before I get to the thumb pad I want say that not long after we began to use the new G4 I noticed an odd video noise on the screen when the receiver transitioned from screen to screen. It happens mostly when entering a BG, a garbled image appears as the receiver switches from one screen to the next. I never noticed a decrease in the receiver's accuracy so I assumed that the video noise wasn't a critical issue and decided not to call CS over what I deemed a cosmetic glitch.

A few weeks later the thumb pad began acting up. The thumb pad is basically five buttons, up, down, left, right and center. The donut shaped disc handles the directional clicks and the small nub in the middle, selects. Our unit's disc began to not go back into place after selecting down. The disc would rock as it should toward the down selection but then never fully return to it's starting point. I felt like it was only a matter of time before the disc became worn further. I imagined that soon instead of just getting stuck in the down position the disc was going to pop out. I let things go for as long as I could and then I called DexCom this past Saturday morning.

I explained that the thumb pad was loose and getting worse. The kind woman on the phone asked politely if I had dropped it, we hadn't. She verified my address, apologized that it wouldn't be able to ship until Monday and explained how I should go about making the switch once the new unit arrived. The entire call took less then five minutes. It was very pleasant.

It seems that I timed my phone call almost perfectly as nine hours later, as we were preparing to eat dinner for the first time at Harold's in Edison, NJ, (you may have seen the picture on FaceBook of Arden with our "slice" of cake) the thumb pad fell out completely. I used a piece of packing tape to hold everthing in place until Tuesday. Here's what the unit looks like when the thumb pad comes off:

 

Initially I wanted to be annoyed that the receiver had issues after such a short time, but instead I took a more reasonable position. New technology is prone to issues like this, early adopters take a risk in my opinion. As long as the manufacturer stands behind the product and doesn't make its replacement a headache, I'm okay with stuff like this happening. I wish it wouldn't, but I understand. I hope that my issue is either isolated or promptly addressed by DexCom. Who knows, maybe it already has been in more recent runs of the product.

If you are seeing this issue with your unit, It's my opinion is that you can expect it to eventually become a problem that will need your attention.

Everyone Poops

Link is to Barnes and Noble

The Children's book Everyone Poops takes away the stigma of talking about bowl movements with your children. Both of my kids read this weird little gem when they were potty training and I hope that you did as well, because I got some shit to talk about.

The first time I thought that I was imagining things, the second time it seemed like a coincidence. I ignored the fact that Arden's BG seemed to fall after she, well, pooped. Then one day a few weeks ago Kelly mentioned it to me and last week I saw someone on FaceBook ask the question. Today, we are going to get to the bottom (pun intended and it won't be the last one) of this most vexing, strange, yet natural type I diabetes question.

Everyone poops, but is everyone's BG effected by having one in the chamber?

I'm considering making an addition to the endless questions that I ask when I can't figure out why Arden's blood glucose won't come down. In the past it was, did she eat something I don't know about, maybe I mis-calculated carbs, do we have a bad site and the rest of the usual suspects. I'm getting close to asking, "when was the last time you made a number two" to that list.

My parental detective work can only take me so far. I need help. I need to know the answers to a couple of more scientific questions that I'm hoping you may have some insight about.

• Does our waste material still contain carbohydrates?

• If yes, are the carbs being leached from the intestines?

• If no, what is it about having a belly full that could raise BGs?

This is the only hypothesis that makes sense to me but I am more then willing to believe that I am, you'll excuse me for this but, full of crap. I have witnessed this oddity consistently over a long enough period of time to say that we see higher BGs when it's been awhile since a BM. Moreover, these BGs always seem to drop rapidly after the completion of a belated constitutional.

So that's it. If you've noticed this phenomenon please leave a comment and share your observations. If you haven't, please keep your eyes open and report back with the skinny (thought I was going to say poop didn't you?).

Final Version of my Book Cover Revealed!

It's here, I'm giddy!

There isn't too much to say other then I am genuinely happy to be able to share the final version of the cover to my new book Life Is Short, Laundry Is Eternal here on Arden's Day before it appears anywhere else.

The cover will begin to populate on Amazon, Barnes & Noble and other seller's websites in the coming days and weeks along with new and specific page length information, chapter titles and much more. You can Pre-Order a paperback copy today, eBook readers will have to wait until closer to the release date on April 2nd.

I've added a new page to Arden's Day that contains all of the information pertaining to the book. You can reach it by clicking on the cover in the sidebar, this link or at the heavy-handed and slightly embarrassing, 'Buy My Book' tab in the navigation bar.

Thank you all so much for taking this crazy ride with me, look for a new blog piece about type I diabetes coming tomorrow morning titled, 'Everyone Poops'... I know, what could that be about?

A Day in the Life of a Diabetes Dad

I want to thank the Co-founder and President of Diabetes Daily David Edelmann for inviting me to contribute periodically to his wonderful site. Moreover, I want to thank him for understanding when I expressed my desire to repost on Arden's Day, in it's entirety, my work after it had run on his site. This is not the norm and generous of David to agree to. Reposting is not an attempt to "double-dip", it is being done so that all of my diabetes writing can be housed on Arden's Day for reasons of backup, cataloging and posterity. Please know that I was not paid for writing on Diabetes Daily nor did I compensate them. With that said, here is my second piece for Diabetes Daily as it ran on December 26, 2012.

What do you imagine was the most difficult aspect for me when I sat down to tell you about a ‘Day in the Life’ of a child and her father who are living with diabetes?

The most difficult part was deciding where to begin chronologically…because our day never really ends.

Since I’m not a fan of blog posts that read like log books, I’ll spare you the “7:15… my alarm goes off” style that comes to mind when you hear, ‘Day in the Life’ and instead tell you a few stories that will bring you closer to understanding a typical day as it plays out in my head, heart and home.

My daughter Arden is eight years old. She’s had type 1 diabetes since a few weeks after her second birthday. I have been a Stay-At-Home Dad for coming up on thirteen years. Before diabetes, morning were hectic, but now….

Drag a comb across my head:

I wake up each day one hour before Arden so I can make adjustments to her blood glucose if they are needed. I decided a long time ago that I would always do my best to make sure that Arden can begin each day with a steady and in range BG. I don’t have type I so I don’t know for sure, but I’ve spoken with adults who do and their descriptions of high and low BGs is heart wrenching. I can think of no worse fate then not feeling in your mind and body like yourself. So even though I know Arden’s BGs won’t be perfect throughout the day, I make sure that she doesn’t have to wake up feeling less then what she deserves.

I make adjustments to her BG around 6:30 am. That’s usually enough time to coax a high number down or a low number up with a negative temp basal. That way when she wakes I can pre-bolus for breakfast, giving her Apidra time to begin it’s fight while she runs through her daily fashion routine. I like to see at least a diagonal arrow down on Arden’s DexCom G4 before she begins to eat breakfast.

#&@#*&$ breakfast is a bitch isn’t it? I’ve taught myself how to let Arden have what she wants in the morning while mitigating her BG spike. It took a long time to find the combination that held that spike down without causing a low three hours later. Most days my system works, but you know, sometimes not so much.

I just became comfortable this year with a lower BG and descending CGM arrow as Arden steps on to her bus. I know that the food will quickly play it’s part during that ride to school, I trust the science of it now but that trust took years to build. Somewhere along that bus ride, the dance begins. Some days I lead, some days diabetes leads. Each new day is a surprise that I meet with a calm that only years of living with diabetes can lend to a person. “Here we go,” I hear those words in my head as Arden walks down our front lawn everyday. Here we go!

Arden is in third grade:

This is a big year for us in regards to diabetes management (sorry, I know some don’t like calling it management, I don’t particularly like it either but it makes the point) in school. During Arden’s first three years she would visit the nurse at every BG check, bolus, and before and after activity and food. This year is way different and very exciting. Arden carries her cell phone with her throughout the day and she and I converse, mostly through text message, making decisions about testing, food, and everything else. She has yet to visit the school nurse this year for one, not one, diabetes related issue. It’s like the coolest thing ever!

Arden’s phone has reminders set and she texts me the information that I need to help her make decisions about her diabetes management. If the reminder doesn’t get her attention, thats okay, my phone has them too. Most conversations go like this:

Arden: 127 diagonal up (we use an emoticon arrow)
Daddy: Okay, let’s look again in 20 mins.
Arden: Now it’s 150 and steady.
Daddy: Leave that, text again at next reminder.
Arden: k
Daddy: Love you.

Arden carries a small bag that holds her phone, OmniPod PDM, lance, a juice box, bit of candy and extra supplies with her throughout the day. We briefly speak before lunch to talk about her bolus and if she feels like she can finish her meal. It’s a lovely way to do things that wasn’t easy to set up on the school side, it took time and patience but I’m so happy that I handled things the way that I did. We’ve slowly built a solid relationship and no one is happier then the school that Arden is no longer missing class to visit the nurse.

If I struggle with BGs, and of course I do, the worst time is after school:

The bolus that is needed to hold down a lunch time spike is bigger then I’d like because there is no opportunity for Arden to prebolus the meal. Recess is immediately before lunch. No big deal but it does leave her CGM line drifting down around 4:30 p.m. It’s a slow decline but one that needs to be addresses with food. I can’t make basal changes to help because, as anyone with diabetes can tell you, it doesn’t happen consistently. I strongly dislike the pre dinner snack. I frequently under value the carbs or the bolus doesn’t have time to work before dinner. Something always gets askewed this time of day.

Dinner, practices, homework, shower, bed:

If only it were that easy. Dinner bolus, I am always later with that bolus then I want to be. Then there’s that small but normally stubborn post meal spike. Nothing of course makes homework more of a chore then it already is then a high BG. During the spring and summer Arden has softball, during the winter, it’s basketball. My son Cole has the same schedule and so this time of day goes by the fastest, it’s the most difficult to maintain control of and It sucks.

Dad, I’m hungry:

The bedtime snack adds three more hours to my management day, “three hours,” who am I kidding, it’s more like five. We always get a nice pre bolus in before a bedtime snack but Arden’s BGs can be difficult at this time of night. It’s a literal crap shoot. The correct amount of insulin is always either too much or not enough. On the evenings that everything actually works out as intended, I genuinely don’t know what to do.

It’s between 9 p.m. and 2 a.m. that I get the most done around the house. Laundry, dishes, a little TiVo. I’m generally exhausted by 10 pm having spent my day literally living my life and mentally walking through Arden’s, but this is not the time to rest. Diabetes keeps on chugging along. Having a CGM makes the entire exercise significantly easier. Back in the day I’d be sneaking into rooms to test at set intervals, now those test are less frequent and the new DexCom has a great signal range so often I can keep it with me, eliminating the need to run back and forth to Arden’s room.

With some luck Arden won’t need more insulin after she has gone to sleep, but I’d estimate that she does about three times a week. I don’t go to sleep until I’m sure that there is no more active insulin in her body. On good nights I hit the pillow around 1 am. Most nights it’s 2, but 3 or 4 isn’t unheard of.

I’ve taught myself to live well on five hours of sleep, I normally get those hours between 2 and 7 am. It’s all worth it when Arden wakes up in range.

I guess that is why I choose to begin this story in the morning, not because it’s the beginning to my day chronologically, my days don’t feel like they begin or end. Quite honesty, my days haven’t felt like they’ve reset since the day Arden was diagnosed.

I think that I choose the morning because her face renews me everyday when I see her open her eyes feeling like herself.

Please Test

I need this post to accomplish two distinct and important goals. The first one will be simple. I want to thank my wife Kelly and my daughter Arden for both being so amazing. You'll see why in just a moment...

Second and maybe more importantly, I want to take this opportunity to remind everyone that while CGM technology is fantastic, it isn't foolproof. Because of that sometimes ignorable fact, we always have to test. Normally when we speak about this topic it's in response to the notion that you shouldn't bolus based on a CGM number. While bolusing without testing is something that we should never do, most of us probably have... but we shouldn't becasue CGM technology is designed to be used in addition to testing, not in place of.

Tonight while I was with my son Cole at his baseball practice (yes I know it's January) Arden's CGM alarmed and reported, "101 arrow straight down". Kelly, being the D-mom rock star that she is, tested.

Please test because sometimes, not often, but sometimes, 101 is actually 36. The DexCom CGM technology is so wonderful that it's easy to forget that it isn't perfect. I've been as guilty as the next person of leaning on it too much when I know that it isn't always spot on. It's difficult not to, especially after the sensor has been on for days and consistently reporting numbers that are so close to our tests. Next time that I'm inclined to think that way, I'm going to remember something that Arden and Kelly told me when I got home and I hope that you will too.

Kelly later said that she tested Arden because Arden said that her eyes "felt funny". Arden told me the next morning that it felt like she had been looking, too long, into a computer screen and then suddenly turned away. "My eyes were getting dark" she told me, with no inclination for how her words were breaking my heart. 

I gave her the bolus a few hours before at dinner that caused this low... and her eyes got dark.

Most moments with type I diabetes are uneventful. Our vigilance gives us the sense that we have the disease under control, but that's a foolish notion. It's only under our control until it decides that it wants to run away. When diabetes decides to run you can't stop it. Your best hope is to chase after and keep it in sight until it gets tired of running. Then you can stand next to it again, pretending that you are partners.

We're vigilant because we can't predict when diabetes will take off running, that's why we test. You aren't taking the test, it isn't you that's being judged. It's a test of diabetes, an indicator for whether diabetes is going to stand next to you and play nice or run away.

Please test.