Monthly Archives: March 2015

Confession time: CGMs.

March 4, 2015 – 10:34 am

So with all of this talk about travel and safety and doing the right thing, I’m still not a consistent continuous glucose monitor user. Here’s my confession:

I don’t want to be a CGM user.

I hope my endocrinologist isn’t looking at this today (she does look in every once in a while). But she’s already familiar with my resistance on the subject. Let me see if I can explain this. I’m sure all of the points I’ll make here can be shot down with common sense wisdom that just about anyone living with diabetes can understand. But there are a few reasons why I haven’t made CGM use habitual.

When I first started using an insulin pump five years ago, I also started wearing a CGM all the time. The CGM I was using was horrible; it had accuracy issues, and it was always painful to insert. It was so frustrating that after about nine months, I gave up on it. I won’t go into it anymore, but I think that was where my reluctance started.

Actually, the biggest, most overriding reason for not wanting to wear a CGM is that I do not want one more thing attached to me 24/7/365. That’s not to say that showing a CGM transmitter in public, at the pool or in the shower at the gym, would cause me embarrassment. Those days are long over. I couldn’t care less about that, and I certainly didn’t have a problem with it when wearing a CGM during clinical trials.

No, the problem of “one more thing” is bigger than that. It’s not only wearing something else all the time. It’s having to plan out site changes for two devices rather than one. It’s having to pack supplies for two devices rather than one. It’s fighting with insurance profiteers over coverage of two devices (and supplies for those devices) rather than one. It’s having to carry around a receiver in my already overcrowded pockets. It’s dealing with real estate issues earlier because I’m constantly violating my body in two places at a time instead of one.

I think there might also be, hidden somewhere deep, an aversion to gathering data for my endocrinologist to go through and find fault with me. My current endo is not like that at all, and I know she would never shame me if my numbers didn’t look so great. However, old wounds take time to heal. On the other hand, this would probably be the easiest place for me to give a little. In reality, I know this would not be an issue, so why should I continue to make it one? Patients are not always perfect either.

After going over my concerns with my endo, she suggested that instead of wearing a CGM full time, maybe I use one for ten days or two weeks in between appointments. That way, she could at least get a little data on how my BGs were trending throughout each day. This seems reasonable, and not too intrusive. But has that made me start the process over again? No. Old wounds take time to heal, and old habits die hard.

I’m not sure I’m solving anything here. But this is how I deal with issues like this: I talk about them, to myself, family, and friends, and in doing so, I often talk away some of the concerns (read: fears) of change. I know that CGM technology is better, and with the rollout of Nightscout and Dexcom Share, many people are able to add an additional layer of security in the advent of a hypo away from home. Why wouldn’t I want to make that a part of my care too?

I don’t think I’m there yet. But I’m getting closer. Secretly, I’ve even made lists of who I would share my data with… even “backups”.


 
 
 

By StephenS | Posted in Diabetes Technology | Tagged , , , | Comments (10)

Be safe, take advantage of the opportunity.

March 2, 2015 – 9:30 am

Since this blog is about diabetes, naturally, part of it is going to be about my diabetes. Today, it’s about my diabetes and the challenges of travel. I’ve spent a fair amount of time talking about diabetes and travel on Twitter recently, and a little on Facebook too. Sorry about that. This is what’s happening in my life right now.

First, what this post isn’t: IT IS NOT MEDICAL ADVICE. Please check with your physician, endocrinologist, or diabetes educator before traveling, and certainly before making any changes in your diabetes routine.

Now, what this post is: It’s a few things I’ve learned over the years. Not exactly what to do for specific circumstances, but rather some things to keep in mind as you travel from place to place. Feel free to add to the list by leaving a comment below. More information is always better than less.

1. Check with your physician, endocrinologist, diabetes educator, or all three before you travel. A no brainer, right? See “What this post isn’t” above. This is especially true if you haven’t traveled for a while. Your medical team may be able to give you expert advice that would take you hours to gather via blogs and other social media. And they can give you a copy of your prescriptions, which is a must to have wherever you are.

2. Changing time zones? Determine a “best practice” scenario for updating pump settings, basal amounts, and dietary needs. I don’t have great advice here, and it’s not backed up by science. Do research (along with your medical team) to find out how to best handle time zone changes, including the possibility of making no time zone changes at all, either with devices or routines (a lot of athletes do this). Again, it’s not backed by science, but what I do is change the time on my pump to match where I’m going when I’m about halfway through my trip. A six hour flight across the country? I change the time to match where I’m going at around the three hour mark. I can’t tell you why this works for me, but it does. Find out what works for you (read #1 above again), and if you can, make it routine.

3. Check your BGs early and often. Travel usually involves a lot of walking, even if you’re just making your way through the airport. Also, a change in time zones, eating out for every meal, and other influences (drinking, anyone?) can make for weird and wonky blood sugar numbers. I have learned, the hard way sometimes, that testing more than I do at home is not only common, it’s necessary when I’m on the road.

4. Never, ever, go to bed with a low or even semi-low blood glucose reading. I don’t care if you’re traveling with your spouse. I don’t care if you’re traveling with someone else. I don’t care if you’re staying at a friend’s house. We can’t always avoid hypoglycemia. But if we’re sure that we’re in a good range when we go to bed, even if the number on the meter is a little high, we’ll be much less likely to encounter a middle-of-the-night low, a disruption to our time away, and a disruption to the time spent with the person we’re with. Again, this is something I’ve learned the hard way. Don’t make my mistakes.

To provide additional peace of mind, consider adding a continuous glucose monitor to help you manage your BGs on the road. Or, if you’re using a CGM now, consider taking it to the next level and employing Nightscout or Dexcom Share technology.

These four things to remember go in addition to the things we already know: Pack enough supplies and medications, wear medical alert information (it may save your life as it has saved mine), and (in the USA) know your rights as a traveler.

As we all know, diabetes is not simple, and it’s not easy. That doesn’t change just because you’re away from home for a few days. In fact, it complicates things. But that is no reason to avoid travel. For me, I think the emphasis needs to be on staying safe and being as ready as possible for anything that might be outside the norm.

Doing so allows me to take advantage of every opportunity possible when I travel. I love to travel. I don’t want to miss out on anything. Managing diabetes on the road can be very different from how I manage things when I’m at home. Remembering these four simple things helps to provide peace of mind for myself, to those I’m traveling with, and those who are waiting for me at home.

Have any outside-the-box traveling and diabetes tips? Feel free to leave yours in a comment below.

By StephenS | Posted in Travel | Tagged , | Comments (6)