The Bliss of the NOT KNOWING

Not long ago,  I went to a teacher training session after school. There was another teacher there that brought her kids with her to our training. I noticed that she had packed them several activities to keep them occupied, and each of them had a full quart-sized ziploc bag full of goldfish crackers. No snack-shaming here...just an observation. 

And of course it was an observation that I probably was alone in making. I mean who even cares what size snack someone else's kid has? But, because our life revolves around counting carbs for every piece of food to touch our lips, I DO notice things like other people's snacks. 

What was really weird was that seeing those bags of goldfish made me feel instantly kind of sad. Just a wave of sad came over me. And I'm totally not one that feels sad often. I'm a glass half -full, look on the bright side, positive-attitude always kind of gal. But my first thought when I saw those goldfish bags was "OMG HOW MANY FREAKING CARBS ARE IN THOSE BAGS? THOSE ARE HUGE BAGS! SO MANY CARBS! SO MUCH INSULIN NEEDED!"

 And then I looked at those kids and thought, they have no idea....they don't have to worry about how many carbs are in the bags. Duh. They can eat as much or as little of those bags as they like and NO ONE has to worry about it. Except maybe mom because they might not be hungry for dinner if they eat the whole bag. 

And then it made me realize that I can't just give Caroline a GIANT bag of goldfish and not worry about how many stupid carbohydrates are in the bag. Not only that, if I WERE to give her a giant bag of goldfish and I calculated the carbs correctly, I'd have to make her wait to eat them until her insulin started working because injected insulin takes at least 20 minutes to have an affect, especially with that carb-load. A healthy pancreas just works like magic in people without Type 1 diabetes! No timing of insulin required. OH! And then I'd have to guess about how MUCH of that bag she would eat. If I gave her insulin for the whole bag, and then she only ate half, she'd have too much insulin running around in her body that would make her blood sugar go low. So that's always fun, trying to guess how much of a food someone is going to want to eat. 

 I rarely have these thoughts. Really, I don't. I just do what we have to do and move on. But I thought back to the bliss of the NOT KNOWING. Not knowing about every single thing about what we are eating, when we are eating it, and a million other factors that come into play.  That was the time in our lives before a Type 1 diabetes diagnosis. when we could eat quart-sized bags of goldfish crackers and not have a care in the world. Those days were nice, the not knowing days. However, I have to say (I can't help looking at the bright side) HAVING to know also makes you more conscious about what you are putting in your mouth and your body. So there's that. We are probably eating healthier than ever since Type 1. Not that we are perfect by any means (see our latest FroYo outing below!) But we are more aware, and that can't be all bad. 

Soooooo, moving on to other things, clinical trial life with the Dexcom G6 and Tandem t:slim with Control IQ has been pretty sweet (no pun intended!). Life just goes on as normal with a few blips here and there. I will say that we are still loving the Dexcom G6 with no fingersticks required and no calibrations. It will be super hard going back to our 670g in a few months and having to do at least 2 (preferably 3) fingerstick calibrations each day. Sigh. Thankful for the amazing technology that we have either way, though! (See, I can't help but be positive!). The t:slim pump with Control IQ is amazing and although it does really the same thing as our 670g, it is less fussy and doesn't need as much attention. Oh and our overnights....amazing. Basically a straight line in range of 90-120 every night. I don't even wake up to check anymore. I just know she's going to be steady and safe. (Except when the pump runs out of insulin...keep reading). 

Anyway, here is our Dexcom 24 hour graph from today. 

You can see that 1) her pump ran out of insulin around 6:00 AM and no one woke up to the alarms so she just didn't get insulin for an hour or so. Amazing how quickly her blood sugar went up due to lack of insulin for a short period of time. Scary, actually. 2) We went to the FroYo place today and each time we go there (before today,) we have severely underestimated the carbs in the bowl, not given her enough insulin, and she's hit mid 300 blood sugars that linger for hours. 

Today I decided I was going to KICK SOME FROYO BUTT and give a crap-ton of insulin right up front. Like A LOT of insulin. More carbs than many people might eat in a day. I knew that she also had soccer later, so I was thinking that even if there was a spike, the activity would bring her down. Have to say that I feel like all things considered, we did pretty well! If I'd been super prepared, I would have made sure she had more insulin working in her system (a pre-bolus) before she sat down to eat. But we didn't go above 250! Next time my goal will be to have a longer pre-bolus and I think it might help eliminate the spike. 

A soccer game helped with that spike from the FroYo with ALLLLLL the toppings. 

And here's what the pump graph looked like during the game. You can see where it suspended the insulin (nothing we did on our part...the pump did that on its own...it's the red area on the graph that means the insulin was suspended) during her game when it saw her blood sugar was dropping due to her activity. This pump is SMART, y'all ;-). She was 75 and steady when we got home. That's NORMAL and awesome. 

Oh one last thing. Our JDRF OneWalk is coming up next weekend. I'm going to link our fundraising site below and if you feel like you want to give a little donation to help people with Type 1 diabetes live a healthier life with better technology and one day help find a CURE for Type 1, you can click on the link below and donate. No donation is too small. If you don't want to donate, it's fine! Just wanted to put it out there just in case! No pressure at all. 

http://www2.jdrf.org/goto/coolcats

Hope everyone has a great rest of their weekend! 

Perfect Storm

So, Cat has been using the t:slim with Control IQ in the clinical trial for about a month. Here are my thoughts:

I do love the fact that it corrects a high blood sugar with 60% of our correction factor once per hour if we underestimate the carbs or don't pre-bolus early enough. That's a nice feature! However, sometimes I wonder if our correction factor is right...the pump uses the data that *I* put in, so if I put the wrong info in the pump, then she will not have a good correction for highs. Honestly it seems sometimes like it's driving her a little too low, so I'll continue to keep an eye on things. We might need to change the correction factor on our end. Also, we love the Dexcom G6 more than anything. It's SO wonderful not to have to calibrate and poke fingers to find out her blood sugar. Once we are finished with the trial, she will go back to her Medtronic 670g pump with 2-3 calibrations a day and at least 2 fingersticks per day. I really hope that Medtronic gets it together with their sensor for the next generation pump and makes it more like Dexcom. The Medtronic CGM that pairs with the 670g pump is awesomely accurate. It just sucks to have to calibrate it twice or more a day. Believe me, I know ALLLLL about it since I'm living it!

Here's just a little info..nothing to do with this particular pump or with the t:slim infusion sets: If your insulin pump infusion set needs to be changed (which is is supposed to be changed every 2-3 days), there is nothing you can do about higher blood sugars until you put in a new infusion site. (Side note: once you've had a foreign object inserted into your skin, in particular a metal needle that infuses insulin under your skin, your body naturally tries to reject it and it does what it is supposed to do to try and heal that wound. Sometimes the insulin is just not absorbing well under the skin due to the area being inflamed from having metal stuck into it.) This particular day was a one of those days for Cat. And of course it always seems to happen at the most inopportune times! Like when I promise her we will go to the frozen yogurt bar after school and get a MEDIUM cup of Fro-Yo with whatever toppings she wants!

We've been talking all week about going to our favorite used book store (The Recycled Reader) and a treat at Berri-licious Frozen Yogurt. We tried to go last Saturday, but Cat was throwing up and having diarrhea after her soccer game, so that kind of dampened our plans. Anyway, last Saturday, we were able to finally go! We both found some cool books that I wanted and we got a pic of her with her JDRF OneWalk shoes for the fundraiser that Jane and her husband Bud so graciously agreed to support!

Anyway, after her Fro-Yo (which I totally guessed the carb count because...what the heck? How can you carb count all that stuff?) and afterwards she started going up and up and up and up, but gradually, so it wasn't like off the charts crazy high.

 I gave her a correction but she still was going up. I changed her site and gave her more of a correction. She needed a site change anyway. This seemed to help.

When it was time for dinner, she was trending down, so I bolused her and hoped for the best. Now she's going down down down...it's like the insulin started working all of a sudden! Sooooo irritating. And the worst part is, the Dexcom lags behind actual blood sugars by about 15 minutes. I just checked her with a fingerstick when I got an alert on her Dexcom, and her actual blood sugar was 80. Not an emergency at all and that does not need to be treated. That lag time stresses me out!

Graph after Fro-Yo and mystery bolus

So, in the end, it wasn't a huge deal. We had a tall mountain peak of high blood sugars that came down relatively quickly and it all ended well. Still...seeing that giant spike always stresses me out. Fortunately it doesn't happen often!

Until next time....

Soccer practice! (short post)

Tonight we had soccer practice at 6:30 PM. We typically eat dinner very early (4:30 or 5PM) on these nights to avoid having too much insulin on board during activity and then dealing with a subsequent low blood sugar.

But today was crazy. I had an after school obligation that kept me from getting home till after 5:30. Husband was at Lowe's trying to purchase a new fridge after ours died from the power surge after Hurricane Dorian. It was just NOT a relaxing afternoon where we could fix an early dinner and get it done in plenty of time before practice.

So about 30 minutes before practice, Cat had a quick and easy dinner consisting of a grilled cheese sandwich, baby carrots and a fruit cup. This might be our "go-to" dinner on soccer practice nights, just sayin'.

Instead of the normal 50g of carbs that I would normally bolus for that meal (25 for the grilled cheese, 20 for the fruit cup, and 5 for the carrots), we bolused 40g and then right before soccer practice started she turned on the "Exercise mode" on her pump. This mode on the t:slim with Control IQ keeps her blood sugar at a higher target range in order to prevent lows. I believe Exercise Mode range for blood sugars is 140-160.

And she had practice for about an hour and a half (it ran over because of a scrimmage with another team). I had forgotten to remind her to bring her phone (not really a phone because it's only used for sharing her Dexcom numbers). So I really wasn't watching her blood sugars at all during practice.

When soccer was over and we were in the car on the way home, I told her to turn off Exercise Mode. And when we were back in the land of Dexcom Share, I saw that her pump did a BEAUTIFUL job of keeping her in range during some pretty strenuous activity! Winner winner chicken dinner! I felt really good about how things worked out and how she was able to remain stable during activity! Especially with insulin on board!

I will say, as far at the graphics on this pump compared to the Medtronic 670g, I'm not a huge fan of how it looks on the t:slim screen. I don't love the big red lines that show insulin was suspended. For some reason, that looks punitive to me....like I did something wrong and now a big red line is reminding me about my wrongness. I much prefer the LACK of pink dots on the Medtronic 670g graph when basal is suspended. I also prefer the blue shield of the Medtronic 670g that just displays the current BG value. I don't care to see the graph unless I want to see the graph. It does not need to be on display all the time.

I do like the touch screen to enter values or change delivery settings on the t:slim though. That is a REALLY nice feature rather than pushing buttons to scroll up and down.

Not unhappy with this graph at all! See how the insulin was suspended during the period of major activity, but no rebound high blood sugar!

11th year Diaversary

I just realized that last month, August, was my 11 year diaversary. For those not in the know, a diaversary is the month and day that you were diagnosed with diabetes. Specifically Type 1 Diabetes (although I guess you could also have a diaversary for Type 2!). People sometimes celebrate this milestone! I always forget about mine until it's over!

Sidenote: Type 1 diabetes is an autoimmune disease. It's not caused by diet or lifestyle. I repeat, if you eat total crap and live on the couch, you will not get Type 1 diabetes because of these lifestyle choices. I wouldn't advocate that you live on the couch eating crap, but it won't cause T1D. Read more about Type 1 diabetes here. 

Anyway, I don't actually remember the exact date in August 2008 that I was diagnosed with diabetes. Maybe it was because on that day, I was incorrectly diagnosed with Type 2 diabetes. I guess it was because of my age. I was 38 years old (almost 39), and who has ever heard of a 38 year old developing Type 1 diabetes! That's just for kids, right? (spoiler...it's not. Type 1 diabetes can be diagnosed at ANY age).

Well, that Saturday sometime in August, 2008, I remember finally deciding that I needed to see a doctor about my constant need to pee. I had googled what that symptom meant, and read that along with extreme thirst, which I also had, it could be a sign of diabetes. Surely not though...it was probably just a urinary tract infection. My husband and I drove to the doctor (they opened for walk-ins on Saturdays till noon) and I waited to be seen. I had been SO tired that summer too...I napped nearly every day after I worked mornings only, four days a week. I remember saying to my husband, "It could be diabetes, but I'm sure it's not!".

The nurse that called me back to be seen was an acquaintance of mine from church. I explained my symptoms and she assured me that it was probably honeymoon cystitis. A urinary tract infection! No worries....we can clear that right up! Let's just do a little urine sample! And my gosh, I had lost some weight, hadn't I? No? Well it sure looked like it!

Five minutes later she and the attending nurse practitioner came in with grave looks on their faces. They needed to check my blood sugar, as the urine test had come back positive for glucose. A fingerstick confirmed a blood sugar of 365 (normal is around 100). They asked me what I had eaten, and when I had eaten last. My breakfast, 2 hours prior, had consisted of a single banana and one hard boiled egg. Hardly a carb-fest! (And even if I HAD loaded up on pancakes and syrup, a blood sugar that high would have never occurred in someone without diabetes.) 

Well, it's Type 2 diabetes, she (the NP) said. Let's give you a shot of insulin to lower your blood sugar for now, and here's an oral medication that you need to start taking. Come back Monday for fasting blood work. Oh, and here's the American Diabetes Association diabetes meal plan (at that time, full of processed food and junky carbs). See you soon!

That following Monday, my bloodwork showed that I was definitely diabetic and that my average blood sugar over the past 3 months was 214 (9.1). Y'all, that's 2x the normal blood sugar for a non-diabetic. Coupled with the fact that I was not overweight, I was not sedentary, and I ate pretty well compared to the standard American diet. This was a ginormous RED FLAG that the NP should have realized, but nope, her "medical opinion" was Type 2 diabetes and that was that. Yes, I do realize that Type 2s can be thin and healthy, but this is NOT the norm. Statistics, y'all.

Over the next month, I worked closely with the diabetes educators and registered dieticians at the local diabetes clinic. These amazing women were the intelligent, educated practitioners that noticed what I was eating and how my corresponding blood sugars did NOT add up to Type 2 diabetes. They encouraged me to request further testing for Type 1 diabetes. When I called the original NP to ask for this blood test, she basically blew me off and would not entertain the idea for additional testing.

Fortunately, a church member and friend of the family was a doctor in that same practice. I spoke with her about my concerns and she agreed to order the testing for Type 1 diabetes. I could tell she was skeptical as well, but she at least listened and ordered the tests!

Fast forward a couple weeks later when the test results, the autoantibody test (GAD 65) came back EXTREMELY positive for the type 1 diabetes antibodies. I was referred to an endocrinologist, who wanted to see me THAT day, and I got started on an insulin therapy immediately. This was approximately one month after my original diagnosis of Type 2 diabetes, and so maybe THIS month, September, should be my diaverary month. It is the month that I was correctly diagnosed with Type 1 diagnosis and started on medication (insulin) that ultimately save my life.

Side note: Although there is no official diagnosis, I've diagnosed myself with LADA. This is a slower-developing autoimmune diabetes that occurs in adults. It's treated with the same insulin therapy as Type 1, and insurance providers don't have a code for LADA, so it's just called Type 1. Read more about LADA here. 

The moral of this story is: Type 1 Diabetes can be diagnosed at ANY age. And health care providers should not automatically assume Type 2 diabetes because of age or any other factors. I know that I am not the only adult that was originally misdiagnosed with Type 2 diabetes, because I've heard the stories. I'm sure I'll write more on this topic later, as it is so important to know this statistic. But that's all for now!

T1D Strong after 11 years!

Also, I want to say that I am SO THANKFUL for my T1D online community. I wouldn't be the person I am today without all of you.

A little over one week with Control IQ

A Week in Review: 

Dashboard Summary from the last week of our t:slim Control IQ trial. 

A full week + one day has passed since Cat started the t:slim pediatric trial. At first, I wasn't sure what to think about it. She had some highs and some lows over the first couple of days, to the point where I wasn't sure I'd made the right choice, having her participate in the trial.

And then school started the Monday after she started wearing the pump. I shared her graphs and how much time she was spending with her insulin suspended (because of the increased activity at school) in my last post.

But after a full week in, and I think we are settling into a new normal. The pump seems to be figuring it out. I honestly can say that this pump/CGM combo has us thinking less about diabetes than we ever have. When things are going well (no pump site failure, like earlier this week), I don't even worry about her numbers. She's had some highs overnight the last couple of nights.  Not sure why (growth hormones? Fat/Protein rise from dinner or dessert?). But I haven't had to get out of bed to correct her because the t:slim does that for me. By morning she's in range and ready to go. In fact, I haven't corrected her at all or even touched her pump except to bolus or to suspend delivery for swimming, etc.

The fact that the Dexcom G6 has NO CALIBRATIONS and NO FINGERSTICKS is more amazing and liberating than I ever thought it would be. Like, a huge stone has been lifted off of my chest. There have been so many times that I have stressed out about when to calibrate on the 670g because blood sugars need to be stable, so that means you don't calibrate after you eat. But if you forget to calibrate and then you eat....then whoops! You might be without CGM data for a few hours till your blood sugar stabilizes. With the Dexcom G6, you just don't have to worry about that at all. I know Cat's dad loves this feature because he was ALWAYS forgetting to calibrate when I was out of town, leading to increased anxiety about loss of CGM data.

Now what I don't love is the Dexcom Follow app. Yes, I know that sounds crazy. But when we were on the 670g, we used Nightscout and it was AMAZING. I could see all sorts of information from her pump besides her blood sugar graph. More about Nightscout later on, but for now, I'll share some of her graphs from T:connect. Oh, and yes, I love T:connect SO MUCH MORE than Medtronic Carelink. SO MUCH MORE. <3

What's so great about Control IQ? Initial impression

Cat had been using a hybrid closed loop insulin pump, the Medtronic Minimed 670g, since January 2018. These hybrid closed-loop pumps (Medtronic 670g and the upcoming Tandem t:slim Control IQ) are different than traditional insulin pumps because they uses data from the Continuous Glucose Monitor (CGM) which in this picture is on her arm, and is checking her blood sugar every five minutes. The data from the CGM drives the amount of insulin delivery to the person wearing the pump.

Cat has been wearing the Medtronic 670g hybrid closed-loop pump with the Guardian 3 sensor and we have LOVED this pump. I've been using it since January 2019. It really keeps her (us) mostly steady unless we have an "oopsie" with carb counting, have a growth spurt, have extra activity, or have a bad pump site. (If you are not familiar, insulin is delivered subcutaneously through a small metal cannula that stays taped down to her skin for 2-3 days). The 670g pump increases or decreases the basal (background) insulin based on her CGM data. So if her blood sugar is trending high, the pump delivers more background insulin. If her blood sugar is trending low, the pump decreases or stops delivering the basal insulin for a while. Medtronic bases their micro-boluses (automatic basal delivery) based on the last 6 days of total daily insulin dosing.

The Tandem Control IQ promises to do this same action PLUS more. Not only does it adjust the basal rates based on the current blood sugar readings, it ALSO gives a correction bolus of insulin each hour if blood sugar is higher than target. So basically, if I mess up her carb counts, or forget to bolus, or if she's eating something that makes her BG go higher than normal for whatever reason, the pump will correct the high blood sugar IN ADDITION TO increasing her basal rates.

Control IQ uses the user-inputed correction factor (ISF) and then does 60% of this factor each hour if the BG is high. I have mostly left her high blood sugars alone because of this neato added feature on the pump. I think this will be a huge help at school. I did notice today that the Control IQ does not adjust basal rates when there is a certain amount of Insulin On Board (or Active Insulin).

Here's another weird thing I've noticed about Control IQ. If you have Active Insulin (Insulin on Board) from say, her dinner, sometimes it won't let me bolus her after dinner if she wants a dessert, even if I put in the carb count. I guess it's got some predictive features going on that I don't understand. Soooo....I guess the pump will correct her later if she starts going up from the Klondike bar? I always thought I needed to cover the carbs, no matter what.

Tandem also bases their basal insulin on the user settings. So if Cat's hourly basal rate is 1.0 units per hour, because that's what she would get on a traditional pump, that's what Control IQ uses. But it does adjust this up or down based on CGM data. Read the link I posted below for all of the deets about the ranges and targets for the Control IQ. I really like that the "Sleep" setting on the t:slim actually has a tighter range for nighttime.

The drawback to Control IQ is that IF your basal settings are not right, and IF your correction factor is not right, you will have some highs and lows. But of course, any pump is only as good as its user's settings. Also, the Control IQ sets the Active Insulin Time to 5 hours. You can't change this in Control IQ, nor can you change the target setting to anything below 110. On the 670g, Active Insulin Time was a huge factor in having success with Auto Mode. With ANY pump, it's important that you have your settings dialed in correctly.

It's a learning curve for sure, but I am really liking the no calibrations and no fingersticks AND the 10 day sensor. I'm looking forward to our 1 week phone conference with our trial coordinator to upload the data and discuss any changes...I'll keep you all posted!

First thing in the morning. You can see the red lines where basal insulin delivery was stopped to prevent a low blood sugar. The high "mountain" was corrected automatically by the pump. I didn't touch it. 

The diamond that is circled is our indicator that Control IQ is turned on. See how the top of the diamond is blue? That means that the pump is increasing the basal insulin because her CGM data says she is above range. 

When I look at the current status, because the diamond has a blue color on the top, I see that yes indeed her basal rate is increased. Typically at this time she gets 1.0 units of insulin per hour, but the pump has decided automatically that based on her blood sugar reading from her CGM, she actually needs MORE basal insulin, so it's giving her 1.54 per hour right now. Smart pump, trying to keep her in range! Also see the "last bolus" amount? I didn't give her that bolus...the pump did. 

Click here to read the ins and outs of the Control IQ system from Diatribe.

https://diatribe.org/tandem%E2%80%99s-control-iq-hybrid-closed-loop-algorithm-submitted-fda

Randomization Appointment today!

Today was another clinical trial appointment day for the Tandem t:slim pediatric Control IQ study. At this appointment they were doing the following: making sure that Cat had worn the Dexcom G6 for at least 11/14 days for the run-in phase (she wore it daily and our first Dex G6 sensor lasted the full 10 days, hooray!), doing a blood draw to test C-Peptide and A1C (norming for the national study), checking a fingerstick A1C, having us fill out several surveys, and then having the computer randomize our participation in the study.

We decided to drive up and drive back all in one day. It made for a LONG day, especially with the torrential rain and thunderstorms on the way home. Ugh. Next time we are getting a hotel.

The BIG QUESTION of the day: Would we be in the control group with our Medtronic 670g in manual mode with a Dexcom G6? Or would be be in the experimental group with the newest t:slim X2 with Control IQ? It was a nail-biter for a little while, for sure!

The blood draw could have been traumatic, but it ended up fine. Our super nice blood-draw guy (who I had met the week before at the TypeOneNation Summit) was very experienced with kids. However, Cat's veins didn't want to cooperate and they kept rolling away. And I made sure she was hydrated! We distracted her with visions of an iTunes gift card. She did great despite the amount of poking and prodding.

Next we filled out bunches of surveys. Surveys for the parents and for Cat. It was all on the computer. Also we did a fingerstick A1C. Yesterday was her regular endo appointment and her fingerstick A1C was 6.3%. Today at the clinic it was 6.6%. The differences in these A1C value serves as a reminder that A1C machines are not always accurate. The machine at your doctor's office, if it isn't calibrated right, may be off by a certain percentage. Regardless, I'll take it. Plus time in range is a new indicator for control, and she was 69% in range according to her Dexcom reports, with only 4% lows. That's AMAZING.  

After that, the endocrinologist and our clinical trial coordinator came in with the AWESOME NEWS! The computer randomization had placed us in the experimental group! We were going home with a new pump. WOOOHOOOO! Two other families were at the clinic that day for THEIR randomization appointments, and they were also in the experimental group. So we all went upstairs for training on the t:slim Control IQ.

The next hour or so we spent setting up our new pump, learning about Control IQ features, and making sure we knew how to work the pump properly. Since she was already using the Dexcom, it was easy to pair her existing sensor with the new pump. Now we can see her numbers RIGHT ON HER PUMP SCREEN. I was really missing that feature from the 670g. 

Here she is, all hooked up and ready to go! This t:slim is much cooler than the one that I had before I got my Medtronic 670g (I had the first generation). I will say I prefer changing the reservoir on the Medtronic 670g to loading the cartridge on the t:slim.  MUCH faster and easier (thank you Medtronic!) And the steps for loading the cartridge on the t:slim have apparently changed since the first gen model. There is "burping" of the cartridge (getting the excess air out) and now you fill the cartridge before you put it on the pump. That is NOT what we did back in the day when I was trained. But whatever! It's all good! 

It's only been a few hours, but our graph is pretty impressive. She had a pretty carb-heavy lunch right before we got hooked up and she's been pretty steady for the last few hours! Can't wait to see what the overnight looks like! I loaded her up on some carbs AND fat for dinner so we'll see how the pump does with that. Also, she had even MORE carbs for dessert (Klondike bar) after her carby fatty dinner of mozzarella sticks, corn and a fruit cup. But the pump wouldn't let us bolus for her Klondike bar. I mean she put in the carbs and her BG automatically populated, but it would not let her bolus. I guess it knows if it's enough insulin so I'm going to just go with it! If our settings are right, it should be all good. However, a pump is only as good as the settings that the user inputs. Soooo, we may have to do some tweaking in a week when we have a phone meeting with the trial coordinator. 

While the Medtronic 670g and the Tandem Control IQ have similar goals (hybrid closed loop system...insulin is delivered based on CGM data), there are some pretty significant differences in how these two pumps work. I'll do a deeper dive into those similarities and differences next time....but for now....STAY TUNED! 

(Diabetes Christmas today! Those of you with pumps know what I mean!)

Trying to be a Pancreas

(I wasn't planning on writing another post so soon after the one I wrote last night, but I felt the need to get this out there and this seemed like the easiest way to do it!)

Day 2 without our Guardian 3 sensor and Auto Mode: 

UGH. I didn't realize how amazing Auto Mode on the Medtronic 670g was keeping Cat's blood sugars. She typically has a flat line overnight and stays around 120. I know that within the Diabetes Online Community (DOC), that is a bigggggggg debate/source of contention...the fact that the 670g has a target of 120 and some people think this is too high and would rather set a target of 80 or 90 and blah blah blah, but I'm OK with us sitting at 120 all night, if we are steady and stable. Call me lazy, call me busy, call me both lazy and busy, but I really don't have time to be a pancreas x 2 ALL OF THE DAMN TIME. I have a full time job outside of the home. I have two other children. I have a dog and two cats. Plus I like to do stuff other than diabetes. Like scroll Facebook. And binge Netflix. So, the Medtronic 670g hybrid closed-loop system has really helped us not have to focus on diabetes as much, and it's been great. 

But yesterday and last night, she was using her regular basal rates and insulin sensitivity factor (ISF) along with the Dexcom. The basal rates are ones that I preset in her pump for use in Manual Mode. And clearly they needed adjusting. 

See that dip between 3 AM and 6AM? That's where I stumbled in and corrected her high blood sugar in the middle of the night. See how it went down, stayed kind of steady for a while, and then went back up? I think that both her ISF was not right nor were her basal rates. I did a major correction this morning and changed both her basal rates and her ISF. She's coming down slowly....I'll have to keep evaluating and adjusting throughout this week.

Please please please let us get in the experimental part of the clinical trial with Control IQ. I am not sure I can handle 4 months of having to be an active pancreas.

Dexcom Vs. Medtronic Guardian Sensor - An Anecdotal Report

For the past week, Cat has been wearing both the Dexcom Continuous Glucose Monitor IN ADDITION TO her Medtronic Guardian 3 sensor that communicates with the Minimed 670g insulin pump.

Since she's doing the "run-in" phase of the pediatric clinical trial for the Tandem t:slim Control-IQ system, I decided to have her wear both and see how they compared. Fortunately, Cat is a good sport and didn't mind wearing two sensors to satisfy her mom's curiosity. 

First, let me backtrack and say that we have had basically no issues with the Medtronic 670g pump. Cat has been wearing hers since January 2018 and I have been wearing mine since January 2019. I am completely happy with the system. We have amazing time-in-range and few incidences of hypoglycemia, which are the new indicators for diabetes control as opposed to the older standard of A1C.

However, I'm not brand-loyal when it comes to insulin pumps and CGMS. Sorry not sorry! I'm always looking for the newest gadget and the latest and greatest in diabetes tech gear. So trialing the Control IQ sounded like a really cool idea! (For what it's worth, I requested to be in the next generation Medtronic 780 pump trials, but the closest trial location was too far for me to drive on a monthly basis). I've used the Omnipod, the first generation Tandem t:slim and now the Medtronic 670g, so I have good experience with insulin pumps. But I will jump on the first ship that sails when it comes to the best technology for managing Type 1 Diabetes!

So ANYWAY, like I said, Cat has been wearing both sensors for the last week. And in my opinion.....

MEDTRONIC GUARDIAN sensors were hands down the most accurate. I'm sure some people will disagree. However, how many naysayers have worn both sensors simultaneously? And I do have data to back this up!

Part of the trial requires that we use their Accu-chek meter to test Cat's BG. So sometimes I used the same drop of blood and checked her BG with both the Contour NextLink 2.4 meter (that is linked to her pump) and the Accu-chek, the clinical trial meter. BOTH meters were always within 5 points of each other when I tested with the SAME drop of blood, so I'd say they were both very accurate. However, when I compared the two meters with the Medtronic Guardian sensor and the Dexcom sensor, the Dexcom sometimes read 20-30 points higher than the two meters AND the Guardian sensor.

I will say there were times that the two sensors were spot on, especially early on. But it seemed like the later in the week that we got, the more the Dex was reading a little higher than everything else. But...who's to say that they Dexcom isn't right and the other three devices were wrong? I mean, there is a margin for error with meters as well. So there's that. I definitely didn't worry that the Dex was reading a little higher at times...it was not so off that I felt the need to calibrate it. And I would rather it trend higher rather than lower, too.

I'll provide some pics of the device comparisons below. Some are close and some are not so close. 

This one was on the first day of the Medtronic sensor. VERY close. I was extremely excited. 

These were a little off, but still within range of each other. NBD. 

Here they were all different, but still within 30% of each other so it was fine. 

This one was a little concerning...that's quite a difference! See how both meters basically matched the 670g but the Dex was 20-30 points higher? We saw this MULTIPLE times over the course of the week. Still within normal, but it was weird how Dex ran high more often than not.  

As far as which we liked the best, I'd say hands-down Cat prefers the Dexcom. The insertion is simple, the taping is simple, the no-finger pricks, no calibrations....MAJOR pluses. Also, the Dexcom G6 has a 10 day wear, opposed to a 7 day wear with the Medtronic sensor. (I've seen many complaints in the Diabetes Online Community about the G6 not lasting the full 10 days, and maybe it won't, but we are at the end of day 8 with no issues so far so I'll call that a win). 

I will have to say I love those features too. But this is week 2 with the Dexcom + Medtronic 670 and I am going to let her wear JUST the Dexcom. And the Dex doesn't talk to her pump. And that means we will lose the "suspend before low" feature in Manual Mode as well as the Auto Mode program which adjusts her basal. We've had really good success with Auto Mode keeping her in range, and I'm going to hate to have to micromanage her pump in order to do the same job. It will be hard! But, I'll deal with it for the sake of science and research for Type 1 diabetes!

And so for this week (week 2), we are NOT wearing a Guardian Sensor with the 670g pump,  and we are using the Dex for boluses without fingersticks or calibrations. Unless we need to fingerstick for whatever reason (her symptoms don't match the number on the Dex, or it's a first day sensor), then the Dexcom will be our guide. 

Next week (Friday) we will find out if we are in the control group for the t:slim (where we will wear the Dex and her medtronic 670 with no Guardian sensor, like we are doing this week), OR in the experimental group (wearing Dex + t:slim with Control IQ). 

I think it's obvious which one we are hoping for....stay tuned!

Clinical Trial begins!

TWO SENSORS!

The clinical trial begins!

Cat was selected to participate in the pediatric trial for the Tandem t:slim Control IQ.  If you aren't aware, Control IQ will be Tandem's answer to a hybrid closed-loop insulin pump system. The Control IQ will not only stop the basal insulin with a predicted low blood sugar, as it does now with Basal IQ, but it's my understanding that Control IQ will auto-correct for high blood sugars, based on CGM data, which the 670g does not do. You can read more about Control IQ here. 

Since January 2018, Cat has been using the Medtronic 670g insulin pump with the Guardian 3 continuous glucose monitor sensors. We have been extremely happy with this system and have had great results with Auto Mode. The Medtronic sensors have been VERY accurate for us as well. I imagine that Control IQ would be similar, but not exactly the same as the hybrid closed-loop Medtronic 670g.

But....new tech is exciting to me, so when I was scrolling through clinical trials (which I do on occasion) and I found a study that was close enough so that Cat could participate, I was ECSTATIC. At first, we were waitlisted for the trial, but then the call came that she was IN! Cat doesn't mind new things either...when I explained what we would be doing, she was all like, "whatever". 

At our first visit, we had our screening appointment. A fingerstick A1C was taken, medical records were reviewed, current pump info was downloaded, and the study was explained in detail to us by the doctor. We signed all of the paperwork. Now, because we've only used the Guardian 3 sensors and not Dexcom for this last 1.5 years, we have to do what is called the "run-in" phase of the trial. All this means is that she has to wear a Dexcom for at least 11 out of the next 14 days. We got set up with the Dexcom G6 including downloading Share and Follow. During the run-in phase, we can still use our Guardian sensors and still use Auto Mode. SO, I thought this would be a great time to do a comparison of the two Continuous Glucose Monitoring Systems! 

I'll post my opinion + data regarding the comparison at the end of the two weeks, after we go back to to meet with the trial coordinator, as well as which part of the study we are randomized to: either the control or the experimental group. The control group wears their regular pump with a dexcom. The experimental group gets to wear the t:slim with the dex and Control IQ! Both groups eventually get to wear the t:slim with Control IQ in the last phase of the trial. 

Fingers crossed we get in the experimental group. I just think it will be really interesting to try the new technology before it's FDA approved! Plus, we are helping pave the way for children to be approved for this new technology when it comes out. 

So far, with today being day 2 of the Dexcom and day 1 of our new Guardian sensor, the numbers have been pretty accurate, and comparable to the fingersticks we've done as well. (Right at this moment Guardian is showing 129 straight arrow, and Dex is showing 127 straight arrow). 

Here is a pic from earlier: 

Cheers to new and improved diabetes technology! 

Inaugural Post

Hello! First post here!

Quick backstory...I'll write more in detail later on in other posts, but I'm a Type 1 diabetes mom to a Type 1 diabetes daughter.

I was diagnosed as an adult...age 38. My daughter, Cat, was diagnosed as a 7 year old, on Thanksgiving Day.

We are both Medtronic 670g pumpers, JDRF OneWalkers, and insulin-using superheros!!! I am gluten-free/lowish carb eating. Cat is free to eat whatever she wants as long as she covers it with insulin.

In the following blog posts, I'll share our stories, our day-to-day life experiences, recipes, Type 1 research information, other amazing Type 1 diabetes bloggers and podcasters, and whatever I feel like sharing.