Step By Step, Day By Day…

I tend to harp on Diabetes a lot and complain about the many complications that accompany the disorder. And rightfully so, considering how many issues Diabetes can cause in one’s daily life. Just one day can be a chaotic turmoil of problems that can affect other areas of your life. Enter: last Saturday night…

I started Continuous Glucose Monitoring about a week and a half ago, in anticipation of turning on the Auto Mode on my new insulin pump. Auto mode is pretty sweet as it takes a lot of the guess work out of trying to keep blood sugars in range. Working in tandem with the CGM, auto mode tracks your blood sugars every five minutes and makes adjustments on that basis. If it sees that your blood sugars are starting to climb, it’ll increase your basal rate. If it’s starting to drop, it’ll reduce your basal rate or suspend your pump until you even out.

The reviews have been quite positive, considering this particular Medtronic pump has been in use in the United States for the past couple of years. The benefit has been that Canada has gotten to take advantage of their findings without suffering all the trial and error up here. The only active involvement on the user’s part, is the occasional finger prick throughout the day to calibrate the CGM and telling the pump how much carbohydrate they’re eating.

I feel it’s about as close to having an artificial pancreas as one can get, although I have no doubt that the next twenty years could yield some even better technologies. But Auto Mode does require a number of things. For one thing, you need to have a certain amount of sensor data accumulated before activating it. As previously mentioned, you also need to check your blood sugars through a traditional finger prick at least two to four times a day to calibrate the sensor, which is a pain in the ass.

Anyway, I’ve explained all the bell and whistles associated with my new pump before (Presenting, New Medtronic 670G), so you can click on the link for more info. But as with any new technology, there will ALWAYS be trial and error. And that’s what happened to me last Saturday. Let’s examine the timeline, shall we?

Monday, June 22nd: I attend the local MEDEC Centre for CGM and Auto Mode Training. MEDEC means Metabolic & Diabetes Education Centre. This is where I obtained all of my pump training and is also the office my Endocrinologist works out of. Once the training was completed, I was walked through the process of installing CGM and did so in the office, prior to my departure;

Tuesday, June 23rd: Less than 24 hours after first installing CGM, I removed it. Issues late in the previous evening caused a sensor error that couldn’t be corrected. It requested a second calibration and subsequently requested that I install a new sensor. My pump trainer was contacted and we discussed everything from possible scar tissue to simply having bad enough luck to have installed a faulty sensor. He also recommends installing a new one. My fears at letting a machine control my well-being are renewed and I stubbornly refuse to install a second CGM. Not today, SkyNet…

Wednesday, June 24th: After a full day of negotiating with myself, I decide to install a new sensor. I also did it while accompanied by my wife, since she would be the one who would need to apply the adhesives in the event I choose the back of my arm as a sensor site. I cycled a 60k with one of my friends the previous day, which I felt justified my not installing a new sensor right away. I’m pretty good at convincing myself…

Thursday, July 2nd: I’ve worn a sensor for a full week at this point and the pump is now requesting that I replace it. I marvel at the perks I’ve enjoyed during the week, including the pump suspending itself if I hit lows and spending much more time “in range” than I’m accustomed to. I feel somewhat better physically, but I’m absolutely exhausted, either by the hot weather mixed with thunder storms or because my body is finally staring to relax. Or maybe it’s the fact I’ve effectively cut out energy drinks (I say, as I compulsively scratch my forearms and rock back and forth);

Friday, July 3rd: This day taught me an important lesson. I started the morning by doing some intensive yard work in the sun. I followed it up by doing a MetaShred Workout and 30 minutes on the punching pad a little while later. Two workouts, two showers and extended time in the hot Sun taught me that sensor adhesives have a distinct limitation on how well they can stick to a grown man’s belly. In my hubris, I didn’t make a nice, smooth seal of adhesive all the way around the sensor. The result was water getting under the adhesive and drying/evaporating, which ultimately dried out the adhesive and caused the sensor to lift. It lost its footing in my flesh and popped out. One day into a new sensor and I’m forced to replace it because I rushed through the installation. Lesson learned…

Saturday, July 4th: When installing the new sensor last night, I took extra care in applying all the adhesive pads. I basically treated it something akin to putting a new diaper on my newborn, Alex. If I don’t ensure the edges are covered and the bands stick properly, he’ll introduce me to a new level of hell by spewing a volcanic jet of baby waste out the sides. So I essentially treated my sensor with the same amount of attention. And they say that you can’t learn anything from diaper changing! But it’s during the evening and overnight that the proverbial full diaper hit the fan…

• 4:00 pm: My wife bakes a banana bread. My wife’s banana bread is my kryptonite! If I could sit with the pan in front of me and eat the entire thing, I would. Hence, the reason she cut the recipe down to a third of the sugar. A fact I was made aware of AFTER I bolused for my usual two pieces of bread;
• 4:50 pm: My pump alarm goes off and suspends due to a low. I mention it to my wife and become aware of the lessened sugar content. I’m frustrated at the low but tickled pink that the pump is doing its job and I get to keep eating, so I cut myself two more pieces of banana bread. This was a mistake I would pay for later…;
• 8:00 pm: The low and the accompanying correction I dealt with is followed up by my usual feeling of fatigue. My wife is also quite tired and we agree to go to sleep early after getting both kids to bed. I think to myself that I may ACTUALLY get a solid 8 hours’ sleep for a change. Then, I realize that my blood glucose is skyrocketing and a correction is necessary. It takes over an hour to finally fall asleep;
• 3:10 am: I am awoken by a beeping I can’t identify. In my sleep-induced haze, I check my phone before realizing it’s coming from my pump. It tells me that it’s lost sensor signal and to move the pump closer to the sensor. I swear and mumble softly as to not awake my wife, since both items are tethered to my stomach. How much closer do they need to be??? But I had apparently rolled onto the sensor, which caused a problem. I decide to ignore it and allow the problem to correct itself. I go back to sleep;
• 3:30 am: Damn it all to hell! I just manage to fall asleep and the pump starts blaring at me that it needs a calibration. Apparently, my timing was off and I should have tested right before bed. I decide to be lazy and press the pump’s “snooze” option;
• 4:30 am: The pump once again tells me to get up and calibrate via finger prick. I give my pump the proverbial middle finger and hit the snooze button again…;
• 5:30 am: GET UP AND CALIBRATE YOUR DAMN PUMP, SHAWN!!!! Fuck you, pump! You’re not the boss of me! I’ll do as I damn well please… (as I get up, walk downstairs to my office and test my blood sugar) I curl back up into my blankets, give my pump a last cursory glance to ensure no issues. Blood sugar is normalizing and I feel my eyelids getting heavy. I go back to sleep;
• 6:30 am (roughly): Baby Alex starts crying as he realizes that its morning and he considers it a firm injustice that we have the temerity to leave him in his crib. My eyes pop open with the cartoon sound of smashing glass and I fight off the urge to start weeping. My wife, who is the ultimate champion of our household, musters from her slumber and rescues the baby from the torture chamber that is his crib;
• 8:30 am: I awake to the dulcet sounds of Joe Satriani’s Always With Me, Always With You for only the second time in many months, since I usually awake before my alarm goes off. I step away from the bed with an accumulated two or three hours’ of sleep. My wife made coffee. She rules.

Lovely, eh? The life of a Type-1 Diabetic is sprinkled with these lovely days of difficulty and lack of rest. I’m confident that once I get used to it and the Auto Mode is in full swing, I’ll feel better about it and things will get easier. When I first started the pump, I had all sorts of difficulties and there were days I was ready to chuck it out the window. But I couldn’t imagine life without an insulin pump, now. As long as my patience holds out and I stick with it, Auto Mode may just be the ticket to getting my Hemoglobin A1C’s below 7.0, for the first time in over a decade. Here’s hoping… ☯