Diabetes Mine - the all things diabetes blog

Regime Du Jour

A few notes today on what's up with my personal diabetes regimen:

I restarted the Guardian RT continuous monitor a few days ago.  I find that I have to take breaks because my poor belly is scarring up fast due to long-term OmniPod and other sensor wear.  As a result, I'm getting many more frequent occlusion errors -- which means a clog or blockage at the infusion site.  In this case, it's not a tubing or even cannula problem, just a problem of too much thick skin (scar tissue) in the areas where Pods and sensors actually stay on my body.  I do wear the OmniPod on my arm in-between, but I haven't yet figured out how to get the Guardian MiniLink sensor placed there.  And here's why:

The most gi-normous needle I have poked into myself since getting diabetes (or ever).  Not liking that thing!  Also, see that big blue device in the background?  That's the inserter-doohickey.  You have to hold it a pretty exact 45-degree angle to get that big fat needle in right.  How do people manage to use this inserter succesfully on their own shoulders or back, I wonder?  I might need to call my friend's husband, the ICU nurse, to help me out here.

btw, the Medtronic folks requested that I note they have customizable early warning alarms to prevent highs and lows, too, just like Abbott's new Navigator (finally coming to market later this year).  The Guardian gives you a choice of up to 30min. in advance, with alerts that can be set for 5 min. increments. There's also a snooze function, that works just like the one on your alarm clock.  Sometimes I think the finer details of certain features are more important to the engineers than the patients, no?   

In any case, have I mentioned the Apidra?  Yup, I started on Sanofi's new faster fast-acting insulin about two months ago.  I "waited it out" since the first month was rough going for me -- running high a lot in part due to illness and infection.  Now that things have settled down, I still have to honestly report that I haven't noticed any dramatic differences in my post-meal BG levels.  What has changed, however, is how rapidly the corrections kick in, which is a nice plus.  I won't be going back to "slower" insulin any time soon (unless I run out of money -- all that surplus Novolog is still chillin' in my fridge).

And here's something neat: I discovered that my little Securitee Blanket insulin cover is just the perfect size for the Apidra vial!  Very handy.  Although I really do wonder if it hasn't occurred to Sanofi how potentially dangerous it is to make Lantus and Apidra vials the exact same size and shape.  I almost mixed them up more than once. 

I'm still loving the OmniPod, except for aforementioned occlusion issues -- a problem that plagues all pumpers at times, I suppose.  Oh, and that episode about 10 days ago when my PDM suddenly died just as I was attempting to bolus in a tiny little chic French creperie in San Francisco.  When I say "die" I mean it let out a piercing beep that wouldn't stop and flashed a message to call Customer Support asap.  No delivery - Yipes!  Of course I had no backup supplies along. 

Luckily, all we'd ordered was a salmon & feta cheese omelette with salad, so I figured I'd be OK until we got home.  Except for the beeping.  No matter how many times I pushed buttons, it just wouldn't stop.  "Is that you, Mom?  Is that still you?!" my 10-year-old daughter asked sheepishly, as the persnickety French cafe owner glared us down.  I yanked the battery, ate fast, and drove home like a demon.

Thus, the rediscovery of my Securitee Blanket to start carrying extra insulin and supplies around, even when I'm not officially travelling.  You just never know. Insulet did FedEx me a new PDM right quick, I might add. Still, lesson learned.   

Thus, this week's seven words of wisdom for people with diabetes:

Eat carefully.  Test your sugar.  CARRY BACKUPS.

8-Month Checkup: Still Lovin' It

Well it's about 8 months, maybe almost 9, since I started pumping insulin using the tubeless Omnipod system.  Many of you have sent queries wondering whether I'm still on it, and still happy?  The answers are: yes and yes.

We all know there are no miracle cures. But I can honestly say that 1) pumping has changed my life, and 2) there's no way I would be here right now, enjoying pumping, if it weren't for the no-strings-on-me option (currently only offered by Insulet).

PUMPING GOOD
Allow me to remind you that prior to pumping, I was on 8-10 injections per day. Mostly just little pricks from a 31g pen needle, mind you, but that's so not the point.  Pain of injections was never an issue. It was the G-D inconvenience.  And the G-D poor glucose control.  With no way of making micro-corrections, no way of assessing "insulin on board," and only the vaguest idea of what my basal insulin was doing, I was just plain G-D frustrated.  My A1c wasn't bad, but I was having lots of bad days, lots of uncomfortable lows.

Now, as you may know, my post-meal glucose levels are still not perfect (ooh, did I use the "p" word?), but they're mostly good, and I haven't had a bad low in, well... I can't remember exactly how long.  At this very moment, my 90-day BG average comes up as 131, an A1c of about 6.4, according to this chart. I'll take that, sans the lows!

I never have to fuss with screwing on needle caps before I eat. If I decide I want more, I just push a button.  I can go a whole day at Disneyland -- eating and walking at unexpected intervals -- and actually enjoy myself.  Woohoo!

PODING GOOD
And then there's the Pod part. I personally am ecstatic about the all-in-oneness of it.  Meaning the easy-to-use PDM (controller unit) is also my glucose meter.  So I just carry around the one gadget.  I switch off between sticking the pod to my abdomen and my shoulder, and I'm constantly grateful that the unit is unencumbered by long plastic tubing.  I do not want long plastic tubing hanging off my body. Not now. Not ever. 

Have I had troubles with the Omnipod?  A very few.  Twice early on I had to call the company to replace the PDM because the fingerstick meter was acting a little crazy.  Both units kept administering insulin flawlessly, I must add, but the meter needs to work as well.  The company sent a replacement overnight. 

Once or twice I must have hit a vein, because some blood pooled up at the cannula insertion spot, and I got a good squirting when I pulled that pod off. Eeww.  But I'm guessing that sort of thing can happen with any infusion site.  Also when I wear it on the shoulder, the pod sometimes pulls off after hitting a door jam, or after vigorous exercising: the adhesive starts to rip, and then the weight of the unit can dislodge the cannula.  But that's pretty rare.  Once when I had it on my tummy, during a particularly animated lunch conversation, I sort of jumped up to make my point, and ripped the pod right off my belly with the edge of the table. Yikes!  No pain, but also no gain. 

Anyway, these are isolated incidents.  In my work here at DiabetesMine.com, I'm encountering more and more companies with fantastic visions of small wireless insulin pumps.  Neat.  But so far, Insulet is the only one to make this dream come true.  May they make it in good health!

[Editor's Note: Want to hear from other OmniPod users? I believe you can find all 2,450 of them HERE.]

[PS - And if you haven't filled out our survey on the importance of diabetes technology, please do so right now, HERE. Thanks!]

 

OP FAQ -- Strictly Personal

My Inbox continues to overflow with questions about the tube-free OmniPod insulin delivery system, which I've had the privilege of using for the last 5 months.  So I figured I'd be economical about it and compile the answers here for public consumption:

Amy's OmniPod FAQ (Frequently Asked Questions) -- A Strictly Personal Viewpoint:

Now that you’ve had several month's experience with the Pod, how are you liking it?

Me loves it. I can't tell you how convenient it is not to have to mess with needles and pens all day long, not to mention the much improved BG control!  I was down to an A1c of 5.9 at last count, irregardless of a few inevitable SUS episodes along the way.  My best measure of satisfaction is that I'm excited about just having the thing, and still enjoy doing the "show and tell" bit whenever people with good questions inquire.

What are the downsides?

Well, it sort of is like wearing a small brick attached to your abdomen or shoulder.  I would like the pod to be flatter, and less obtrusive, especially during intimate moments.  (Let's just say my husband's a heavy guy -- it's all muscle!! -- so that brick can press into me pretty uncomfortably at times...)

When you wear it on your arm, have you had any problems sleeping on the Pod -- rolling over on it or anything?

Actually, I thought this would be more of a problem than it is.  Most of the time, I don't notice it during sleep at all, even when it's on my shoulder.  Only when I somehow place it smack in the middle of my right shoulder -- the one I sleep on -- do I find it really uncomfortable at night.  Note that the pod itself is not disturbed in any way, no matter how I may roll around on it :)

Have you actually worn the thing with a bikini yet?

NOPO.  In fact, I just treated myself to several new Tankini's for this season.  The pod's pretty well hidden under them, and thankfully they are "in" right now.  But this is strictly personal preference: I do now have one diabetic friend at the gym (!) who wears a bikini unabashedly with her Minimed pump hanging out.  I love the little round un-tan spots from her former infusion sites. I love the fact that should could care less. 

How far apart can the pod and the pump be, and still communicate?

A few feet, I believe, although that's hardly an issue since you usually have the PDM in your hand -- and therefore close to the pod on your bod -- whenever dosing or entering commands.  The bigger issue is that you've got to have the PDM angled right (not too high up or facing the wrong way), otherwise you get a "pod status not available" message.  Meanwhile, if you choose to leave the PDM behind while going off for a several-hour bike ride (my bad), the pump will continue to deliver whatever basal rate is programmed, even without the PDM being nearby.  If you urgently needed to stop delivery, you can always just remove the pod.

Have you had an problems with infection at the insertion sites?

Thankfully no.  I did have a little trouble with the adhesive peeling off, so the Insulet rep recommended Mastisol, which worked great.  But last week for the first time, my skin got all irritated under the adhesive, so I may have to try another brand of medical adhesive spray/cream.

Does the flow of insulin get impeded, leading to getting less insulin that you think?  If so, is it easy to “unstuck” the flow?

Haven't had any experience at all with that -- even when I thought maybe the pod was delivering less insulin (because I'd hit a high BG patch), I pulled the pod to check and discovered it wasn't at fault at all.  Since there's no tubing, and only a tiny cannula for the insulin to travel between the pod and your skin, it seems extremely unlikely that the flow would get blocked in any way.

Does the device allow a major bolus "hit" if necessary, or do you manage that using the old-fashioned syringe?

Weird question.  This is insulin pumping.  No more shots involved.

What's the status on insurance coverage for the OmniPod?

The company tells me lots of plans already cover the OmniPod, including several in California.  I'm not up on exactly which plans or to what extent (not my department).  For specifics, please call the company at 800-591-3455.

Do you track other manufacturers to see if someone will out-pod the pod?

Why yes, of course.  Not that I want to see Insulet get trampled or anything (!) -- I'm just always looking and hoping for something new and better.  Aren't we all?  I recently posted reports on some pretty exciting stuff currently being developed: a "nano-pump" from two Swiss companies, and the next generation in patch pumps, reportedly coming from Medingo Medical Solutions in Israel.  There's even more new stuff on the horizon, so keep your eyes peeled for reports here at DiabetesMine.com.

OmniPod: The IOB Issue

As a follow-up to my latest OmniPod report, I have done some homework on the Insulin on Board (IOB) issue.  Of course, I couldn't let this go :) 

It turns out I opened a big can of worms, 'cause this feature is highly complex. 

First I queried Insulet Corp. on why they made their IOB (aka BOB for "bolus on board") function work the way it does: it currently shows only insulin delivered as a correction -- and not remaining insulin from a meal bolus -- therefore it can prompt the user to take a post-meal correction too soon after eating if the BG reading is too high.  When I posted this, some folks shouted that this approach was "disconcerting" and potentially "a big safety issue."

Hmm, representatives of Insulet tell me that during product development, they surveyed a number of doctors, and the consensus was split fifty-fifty on how to handle IOB.  Some pumps, like the Paradigm, apparently treat IOB exactly the same way.  But many others do consider remaining meal bolus, and based on this, block the user from taking another meal bolus while a previous one remains in the system.  In other words, if you wanted to eat an additional apple after a meal, the pump wouldn't let you bolus for that food while it still sees an active bolus dose.

Insulet apparently wanted to give users the freedom to bolus again without hesitation. But of course we have to be careful. This can lead to insulin stacking and lows.

However, the Insulet folks did say that considering customer feedback on their IOB function is "on the top of our priority list for future development."  I guess I'm not the only one tripped up by it. 

Meanwhile, I also queried a couple of pumping experts on the whole IOB/BOB function, and their thoughts on safety and efficacy:

* Virginia Valentine wrote back to me, saying simply, "I would agree that using only the correction for the IOB does not make sense."

* John Walsh, author of Pumping Insulin, had A LOT more to say --

"I have had a few Paradigm patients and talked with several others who are in relatively good control except that they have "unexplained" hypoglycemia that is sometimes frequent. Unexplained, that is, until I show them that their pump is not subtracting any BOB when it is in excess of their correction need from the carbs they are eating.  The recommended boluses in these two pumps as well as in the Animas (when the BG is above target) will be excessive whenever the BOB is greater than the correction need.

From my unpublished data, this situation arises in 1 out of every 9 boluses (or about every two and a half days for the average pump user), although I would estimate that in only 1 out of every 20 boluses would the dose be sufficient to cause a significant low.  Well over two-thirds of boluses are given with BOB present.

This danger is offset to some extent by the relatively high average glucose levels for most pumpers, but I cannot explain the logic for why these pumps were set up to handle BOB in this way. The engineers appeared to lack direction from a competent medical board. The only rationale that I have been offered after much questioning is that "All carbs need to be covered by a bolus." Well, excess BOB is exactly that, bolus insulin. Why any excess bolus insulin taken earlier in the day should not count as much as a current bolus baffles me.

Two other things need to be kept foremost in mind for an accurate BOB calculation. The first is whether the duration of insulin action has been correctly set. Many pumpers set their DIA too short. When they do this they hide the true activity of their boluses.

The second is that BOB is only calculated after a BG has been entered into the pump. The pump cannot accurately account for BOB unless it has a BG to make a calculation for both carb and correction requirements.

Unfortunately, only about 1 out of 7 boluses has both a carb intake and glucose value entered at the same time. Most pumpers are doing blind bolusing."

Eeew, that sounds scary.  Since I've actually had relatively few lows since starting on the OmniPod in February, I guess I'm flying pretty well "blind" over here.

In any case, if you want to learn more about how the D-industry handles BOB, see John's latest presentation on the issue, especially slide 19.  This man knows his stuff.

OmniPod Update

Speaking of anniversaries, this Saturday marked my three-month milepost using Insulet's revolutionary new wireless insulin delivery system, the OmniPod.  I feel I owe you all an update.  So if the details of cutting-edge insulin pumping interest you, read on :)

THE BIG PICTURE
On the whole, I'm at a loss for words to describe how thoroughly this product has changed my life.  Let's just say (conservatively), that I was taking about 6 injections/day before.  That's at least 540 injections I've been able to skip in the last three months.  Hallelujah!

But skipping injections is a benefit of any insulin pump, of course.  The thing for me is, despite the no-needles advantage, I am 100% certain I would not be a pumper right now if my only choice had been a traditional pump attached to my body via 43" of plastic tubing.  That's still a big No Thank You for me. 

With the OmniPod, it almost feels like all I have to deal with is a glucose meter. Period. Because the PDM (wireless controller unit) actually doubles as a glucose meter, and it's all I need to carry around.  (God, how I love that!) I just check my BG, and the bolus wizard tells me automatically how much bolus or correction insulin I need.  I don't even have to deal with the two-step process of using a separate meter and then plugging the results into my pump.

And that issue about losing the controller unit?  Get over it!  First off, we all have to carry our glucose meters around: do you lose yours regularly?  I personally never have.  Also, as one fellow OmniPoder put it: "It's a valuable like my car keys or my wallet. They go with me wherever I go, and I'm careful not to lose those, either."

THE NITTY GRITTY
Obviously, with any medical device determining your health and well-being 24/7, customer service is key.  I wanted to note how fabulous the people over at Insulet have been -- and not just to me, 'cause I publish on the web; I happen to know that lots of other customers are having the same great experience.

As a responsible blogger, I did want to report that after I complained here about the innacuracy of the OmniPod's built-in FreeStyle meter, Insulet contacted me immediately and offered a replacement unit.  Apparently the problems I was encountering are not common.  I suppose I could/should have called them right away with my concerns, but I just assumed that most next-gen products run into a few bugs initially.  Anyway, the new PDM unit arrived via next-day FedEx, and after a very long tech support phone call to help me transfer all my settings, I am up and running and highly accurate again!  (Note to self: never work in Customer Support, as it requires too much patience)

As far as daily pumping goes, I'm still experimenting with correction factors and basal rate options.  For example, I just learned that the OP "insulin on board" feature only shows insulin delivered as a correction -- not a meal bolus -- therefore I've often taken a post-meal correction too soon after eating, knocking myself into a nasty low.  You live and learn.

I've set three different temp basals for workouts so far, and am still trying to figure out how low to go versus eating during and around cycling workouts.  As any Type 1 serious about cycling will tell you, this is a science unto itself. 

I've also been alternating belly and behind-the-shoulder sites -- trying to predict what I'll be doing that week for optimal placement.  I hate wearing the unit on my shoulder during aerobics, not so much 'cause it looks silly as that it bobs around too much (even on my skinny arms).  For cycling, however, it's perfect on the shoulder.  Although I find I have to contort a bit and hold the PDM behind my shoulder whenever I want to bolus or get a Pod status -- otherwise it doesn't connect. (All little stuff that shouldn't be an issue versus the massive inconvenience of injections, but see?  The OmniPod's got me spoiled now...)

MIND GAMES
This might sound twisted, but I actually love changing the pod. It's a very simple process, and every time I do it, it reminds me how very ecstatic I am to have the OmniPod. Lookey here! See that big needle?  That's not going in me, no sir!  That's just to fill the pod... and then click! the cannula is inserted automatically and I'm on my way.

OK, but the final truth of it all is, it's still hard having diabetes... I'm still running over 180 a lot of afternoons (lunch is always such a crap shoot), and I'm either too high or too low many nights -- often seemingly without rhyme or reason.  USER ERROR, I know.  What the MD's might have once called "noncompliant"?  Aw, shut up!  Even with the greatest D-management tool ever invented, it's still a volatile disease and I still want to have a life...  What I'm most grateful for is that the people at Insulet Corp. seem to understand that.

Living With It

I suppose it might be different for people diagnosed as children, who can hardly remember what life was like without diabetes.  But for me, diagnosed in my mid-30's, it still shocks me sometimes...

Sometimes lying in bed at night, I think maybe it's all a mistake -- maybe I could just stop taking all the meds and using all these devices, and my body would just go back to doing what it used to do.  Maybe it was just a blip, like a bad cold or rash that hung on so long you almost believed you'd have it forever.

Sometimes when I have a really bad day (like this Saturday), where my blood sugar plummets to 60 and later soars to just under 300, the frustration is hard to reign in.  I know it's the disease making me moody, but knowing that doesn't make it any easier.  I'm just so GD mad and sick of it all!

And here I am, one of the incredibly lucky ones: nearly two months ago I started on the new OmniPod tubeless insulin pump, generally considered the state-of-the-art insulin therapy at the moment.  And it is amazing.  From a design standpoint, this two-part system is in a league of its own. The little insulin pod that you attach to your body is controlled wirelessly from a compact unit that looks and feels similar to any consumer PDA, and uses simple English language for commands. 

I call the OmniPod my little miracle machine, since it's made life so much easier and more pleasant than when I was on shots.  Talk about frustration: the newspapers like to report that pumps replace (gasp!) "up to 4-5 injections a day."  Hell, with my crazy schedule and all the corrections, I was up to more like eight.  And trying to "fine-tune" my dosing was like playing pool with a blindfold on.

So I'm fortunate and deeply grateful to companies like Insulet...

But then it hits me: pending the miracle of a cure, this thing isn't going away.  And when I consider living the rest of my life with this XL half-kiwi lump on my abdomen, I don't feel so lucky. Every time that unit on my belly presses against something and it hurts, or I wear it on my arm and it catches on the door jam and nearly pulls off... Every time I look closely at my overloaded purse, containing at least 3 separate and distinct digital devices (don't get me started on packing for travel with diabetes!), I pray silently for further innovations and convergence.

The time has come for those of us living with these devices to stop quietly accepting what we're given, and rather make some noise about what we really want as these products evolve.   

Just some additional thoughts from one of 20m+ Americans living with it...

Armed

So... It's officially been 5 weeks since I started on the OmniPod, and I finally tried it on my arm.  Armed.  Banded.  Armbanded.  Weird.

Already, I was so accustomed to wearing that box on my stomach that I startle each time I notice my empty abdomen: Where-oh-where has my pump gone?  Have I lost it?  Ah no, the shoulder. That's right.  It did feel a little achy back there when I wasn't looking.

Actually, the insertion hurt even less on the arm than it did on my tummy, so I was pleased with that.  And I love being lump-free in the middle. But I also forgot how strange it might look without sleeves.  As I pulled off my sweatshirt in aerobics class the other morning, a friend approached to ask, "What's that on your arm?"  "Oh, you know I'm really a Cyborg, right?"  No one else asked any questions.  But I couldn't stop looking at it in the mirror.  Hmm, definitely better covered by my workout tops in that setting.

Admittedly, I've also run into a few door jams. I've got to readjust my perception of the width of my shoulders, and/or try moving the Pod a little lower and further back on my arm.

But for sleeping, the arm site has turned out to be even more comfortable than the stomach.  I sleep on my right side a lot, so was careful to attach the Pod to the left shoulder where I wouldn't lay on it. No Problemo.  Never notice it -- as opposed to on the tummy, where I somehow managed to roll partially onto it no matter which end it was oriented towards...

Still, the arm site doesn't look as cool on me as it does on pop star Nick Jonas, for example.  With a box on the upper arm, guys kind of get this rebel look -- like they're sporting a pack of cigarettes.  Me, I just look like some dippy soccer mom who maybe taped her cell phone to her shoulder.  *Sigh*

Nevertheless, I love having options.  In three days' time, I'll have to move it again anyway.  Maybe I'll save the Arm Trick for next time this soccer mom gets the opportunity to go hot-tubbing.  Good thing we modern Cyborgs are otherwise waterproof ;)

Too Sexy for My... Pod?

So here it is.  One of the big perplexities of insulin pumping: Am I sexy with this thing on?  I know, I know, sexy is as sexy does.  But still...

As I mentioned the other day, a fellow OmniPod-er recently wrote to me:  "Somebody mentioned that (the pods) looked like 'tumors' and I just can't get that image out of my mind.  I am concerned about their sex appeal even though my husband said he isn't bothered by its presence." -- JT

All I know is that back when I first started wearing the DexCom's little black box adhered to my tummy, I was feeling equally bionic and strange. The first time my husband caught me undressing with the thing on, I smiled at him sheepishly and said, "Naked with sensor..."  to which he replied by looking me up and down, raising his eyebrows and saying, "I see lots of sensors!"

Check!

That was either True Love in action, or a quintessential Guy Thing -- as in, as long as all the female essentials are in place, what's a little bit of hardware? 

Seems as if I'm the one who's a bit distracted.  I try not to focus on it, but I am aware of its presence --  interuppting the smoothness of my birthday suit -- during intimate moments.  Luckily, I found a sweet little camisole that spans down to the top of the hips and covers all the machinery.  I bought four different colors.

With my clothes on -- as long as it's nothing too body-hugging -- the pod is virtually invisible and I can honestly say I forget it's even there.  But this is March, remember.  What happens when we're back to Skimpy Clothing Season?  Won't the pod bulge unattractively out of tank tops and sundresses?  I'm running out of virgin "real estate" to place the pod on my abdomen, and I haven't even experimented with sites on my arms yet...  And what about that drawer full of bikinis?  Time to go Tankini shopping again, I guess.

As disconcerting as this may seem, every time I look at my belly, I remind myself how cool the OmniPod's little self-contained unit actually is.  With a traditional pump, I'd be dealing with that long plastic tube coming out of my body, with a box on the end of it.  That's a lot to negotiate around your clothing -- especially dresses and anything else one-piece with no split in the middle to run your tube through.  So there's a little lump under my teddy, so what?

I know you can disconnect a traditional pump and therefore enjoy some limited time untethered, but everything in life is a trade-off, no?  I trade not being able to temporarily disconnect for not wearing medical tubing every other moment of my life.  I trade the lump for the freedom it gives me.

And when it comes to the Sex Appeal factor, it does seem clear that it isn't my partner's perception at risk here, but my own.  We body-conscious women don't feel sexy unless we... well, feel sexy. 

Random Thoughts on Pumping without Tubes

You can see that this has been a life-changer for me: I usually don't do anything much "random."  But becoming a pumper -- especially with such an innovative wireless system -- has brought on all sorts of experiences and feelings that don't necessarily stack up in any methodical way.  I'm just letting it all sink in at the moment...

That said, you can read the "aerial view" of my thoughts on becoming a pumper at my newest dLife column this month.  For those of you more curious about the daily nitty-gritty of it all, here are some initial notes:

Regimen Readjustments
Surprisingly, nothing too substantial was required yet. My biggest struggle has been getting the correction factor right. I keep going too low, so readjusting the factor setting, but then sometimes it's not enough after all. Go figure.

Not using extended bolus delivery yet, even though I've been eating steak and margarine and other fat and protein items that could probably benefit from that feature.  We want to establish my baseline insulin requirements first.

Still working out workouts.  The temp basal setting we created -- 50% for three hours around an hour-long workout -- is good, but still I'm going low sometimes.  I believe it's due to too much bolus insulin beforehand.  But since -- regrettably -- I don't always eat the same thing for each meal, it's still a guessing game.

Happy, Happy
I emailed my endo my DexCom records for the first week and she wrote back to me: "Wow!  Those are fantastic numbers, especially considering how much we changed your algorithms from pre-pump! Great work!  Keep it going!" (LOVE this doctor, btw)

Waterproof goodness. The OmniPod scores high on that count!  Oh, how I disliked those shower patches necessary for the DexCom.  So inconvenient -- don't forget to put it on and take it off! -- and costly, too.  I felt guilty any day I showered more than once.  And they irritated my skin as well.  With the OmniPod, water is never a problem unless you're soaking in very hot temperatures, which can kill the insulin, of course.  If you want to bathe or hot tub, you might try wearing the Pod on your upper arm, which will stay out of the hot water.  And no, I haven't tried that trick yet. 

What, That Lump?
A reader who wrote to me recently noted that the Pods might look like "tumors" under your clothes. Yikes! I totally disagree, but it's hard to get that image out of my head. I've invested in a little new lingerie and Victoria's Secret perfume to help maintain the sex appeal factor.  More on that later.

Pod changes: quick snap and a pinch. I definitely do feel a poke when the cannula is inserted -- but it's nothing worse than one of those lancet pricks that hurts a tiny bit more than most. And I love the "automation" of it -- the fact that I don't have to insert the cannula manually myself. 

Wish List
Already a bunch of people have written to me about things they'd like to see in the next-gen OmniPod.  I agree completely: perhaps a smaller pod option, which carries less insulin for those of us who are highly insulin sensitive?  A disconnect option would be nice, too, mainly for jacuzzi-lovers.  And how about a Pod you can wear longer than 3 days?

The latter is of course an FDA approval issue (all the on-body sensor products are currently restricted to 3 day wear to avoid infection).  On the Pod size issue, Insulet tells me it's a battery issue at the moment; the batteries won't fit into a smaller unit as yet. Disconnect?  Well, current design doesn't accommodate it.  But right now, I could actually care less.

I am so happy not injecting and not wearing tubing and achieving better control, that I could kiss someone.  (Where is that cat?)  Right now, I feel like I could never go back!

Pumped, on the OmniPod!

The day unimagined has arrived:  I am a pumper.  I am woman, I wear Pod.  I can't believe I haven't injected myself in 3 entire days! 

So far it's so existence-altering, I hardly know where to begin...  In fact, I'm trying to temper my enthusiasm, so I don't peter out too fast. Meaning I'm reserving my big Happy Dance for when I really start to see results.

But here's how it went so far: On Monday, I met with my endo and the Insulet rep for training (they're just starting roll-out here on the West Coast).  We spent about 2 hours going through the setup and functions of the OmniPod "insulin management system" (please don't call it a pump, 'cause there ain't no tubes on me!)  It was incredibly easy to learn, for one because the menus "walk you through" everything in plain English, and in part probably because I've been writing about and following the progress of this exciting new device for over a year.  So I had a very good idea of what to expect.

Nevertheless, what I wasn't prepared for was the huge shadow it would cast on my diabetes management up until now.  There we were setting basal programs for .4 and .5 units/hour, plus temporary basal programs reduced to -25%, and calculations for "reverse corrections" (the system lops off a little of your bolus if you start out too low).  And all I could think was how LAME my MDI regime was by comparison!  There is NO WAY IN THE WORLD that even the most diligent diabetic could achieve the same BG control with the pathetic imprecision of injections compared to this high-tech wonder of medical science! I thought...

And my next A1c will absolutely HAVE TO reflect the difference. Which is critical, of course.  The nurse ran a quick in-office Metrika kit A1c test on me and came up with a whopping 8.3 (!)  Luckily, my doctor thought it was as odd as I did, considering my good results of late, so we had it re-tested at the lab. Got the results yesterday: 6.2 (!!). So much for on-site A1c testing.  Geez...    

As far as the system goes, I don't mind the Pod a bit so far.  Very comfortable. No need for irritating shower patches since it's waterproof.  What bugs me a little is that my endo insisted I start wearing my DexCom again for the first week of pumping, in order to track results, particularly overnight.  So now I am double-sensored.  Aaack! And I need to conduct fingerstick test on both the OmniPod's built-in FreeStyle meter and the OneTouch necessary for DexCom calibration (I hate the OneTouch).  Aaack x2! What we won't do to thwart this stealthy disease...

Meanwhile, I adore the little PDM (personal diabetes manager) controller device, which has a nice smooth yet solid feel in the hand.  It really does look and feel like your average well-designed personal organizer, so I've got a lot less 'splainin' to do out in public.

And did I mention NO INJECTIONS?  And NO TUBES hanging off my body either?  What an unequivocally Happy Camper I would be...

... if it weren't for the still-unresolved issue of insurance coverage.  We continue to grapple with Blue Shield, which has approved me for a "standard" insulin pump, but is still pushing back on the OP (as of press time).  We went ahead and moved forward on good faith that they'd turn around soon (Insulet has just hired a Regional Manager for this area, who will focus heavily on reimbursement issues).  It's only been a few days, but so far in my eyes the OmniPod is living up to its reputation for excellency -- worth every penny we'll be spending on it.

Editor's Note: Got questions about the OmniPod?  I'm obviously quite the Newbie, but would be happy to attempt to answer any queries to the best of my ability/knowledge.

OmniPoding

Over the weekend I had a chance to meet with Insulet Corp. execs Jeff Smith and Rob Campbell (everyone's in town, remember?)

We had a long talk about the functionality of their exciting new OmniPod tubeless pump and its current market status.  The deal is that the OmniPod is -- theoretically -- available to patients now, but the company is still building out the infrastructure to actually support users around the country.  Unlike other gadgets that can be shipped all over the world immediately, lives depend on medical devices.  Local sales offices and trained educators are an absolute MUST before patients hook themselves up to a life-sustaining device.  So we West-Coasters will just have to wait a while... *sigh*

Meanwhile, the enthusiastic execs talked about the rash of excitement around this product and how their existing customers, mostly located near the company's HQ in Massachusetts, are raving.  There's even a man with just one functioning arm who can now, for the first time ever, change his own infusion set and control his insulin "pump" with his one good hand. He used to have to schlep to his CDE's office every 3 days to have them do it -- which meant he could never travel or be on his own for any length of time.  Imagine his delight with this new system!

Insulet Technology Manager Rob Campbell is a veteran Type 1 himself who's been on the OmniPod for about 6 months.  He admits that he's biased, but everything he told me about wearing it confirmed my conviction that this one's a real life-changer for patients open to something new.

And here's the cool thing: I even got a chance to test it!  Keep in mind that my biggest personal barrier to pump therapy is an aversion to the idea of having a boxy unit hanging off my body via a bunch of plastic tubing.  With small kids and a very active lifestyle, I just KNOW the tube would be getting pulled and caught left and right. No, thanks.

The OmiPod is so different, in fact, that the company's not even calling it a pump, but rather a "discreet, two-part... Insulin Management System." 

My first reaction on seeing it up close was that the Pod (insulin reservoir worn stuck to your skin) was bigger than I expected. It's a bit larger than a plastic dental floss box, I suppose.  But it's a nice smooth design, and it even inserts itself.  Sounds strange, I know, but this means that after using the adhesive to place the Pod on your bod, you just hit a series of commands on the controller unit and the Pod automatically sticks the teeny tiny plastic cannula into your skin with a quickly retracted needlestick.  It was so easy!  The scariest thing about it was the unfamiliar clicking noise. De nada.

I wore the Pod through our entire hour-long meeting, and got to practice pushing buttons on the wireless, handheld controller unit (distributing saline only for practice, of course). Just an hour, but it was quite comfortable -- so much so that I nearly forgot I had it on.

Of course I was curious about life with a Pod: what about swimming, bathing, sleeping and sex?  But Rob and Kelly have both assured me that none of these are problematic.  You can wear the Pod through almost anything, even bathing, as long as the water's not too hot (that will kill the insulin, not the unit). 

I was, in short, duly impressed.  The only frustrating outcome of this encounter was that I'm now more anxious than ever to get myself one of these things.  Ever the impatient patient!

Pump Without Tubing Coming Soon

This is why I am waiting a while to go on the pump: innovative new products making their way to market.

Rumor has it that Insulet Corp's new OmniPod dual insulin delivery and BG monitoring system will be announced as available (via perscription) at the upcoming AADE annual diabetic educators' conference, being held this year in Washington, DC, in mid-August. 

The "pod" uses no tubing but rather is attached directly to the skin via a cannula that is automatically inserted (you just push a button). It delivers insulin according to pre-programmed instructions transmitted wirelessly from the other half of the system, a "Personal Diabetes Manager" (PDM) wireless, hand-held device that controls and monitors the operation of the OmniPod, and is used to check BG levels using FreeStyle test strips.  The system already received FDA approval in January.

Read the whole story on the OmniPod at DiabetesInControl.com.  According to this site, OmniPods will only cost a fraction of what most pumps go for, so doctors should be more willing to prescribe and health plans more willing to cover them.  I hope this is true.  If the early adopters like it well enough, I might be next in line!