Tuesday, March 28, 2006

Comparison Chart of CGMs

Jenny says:
If anyone would like the beginnings of a chart that compares the Guardian RT, the Abott Freestyle Navigator, and the DexCom STS send me an e-mail. I am developing one for a list of parents on the Children with Diabetes Website. It is far from official. I received most of my information from parents of kids that are wearing one of these or from contact from one of the parents to the company. It is just to be used for thought starters.


This technology will change the way we handle diabetes!!!

Thursday, March 23, 2006

Armed and Dangerous!

Jenny says:
We are winning the war today over the breakfast spike. We have been battling without the Guardian RT for 2 weeks to try to figure out this extreme spike on Tommy's breakfast. At his 9:30 test, he is usually in the 300, so I have been inching down his carb ratio and giving him his insulin 20 minutes before he eats! And still always 300 or higher (which means all the other kids are eating snack and he is not.) But today, he is armed and dangerous! He has on the Guardian RT!!! At 9:00, I stopped in school, pulled him out of his classroom and into the hall and had him read his monitor. 180! Ah-ha. "Wait, tell me what it was 5 minutes ago." "174, 168, 165." Here starts the climb. Well not today!!! We told his pump that he was 175 (a little cushion) and then told it that he was going to eat 28 carbs (he eats at 9:30). So the pump gave him 1.9 units. I told Tommy that we are going to win today! And he walked back into his classroom with a big smile!

I am going to go back and check things out at lunchtime. I am being a little more aggressive than normal because we have a back up. However, we turned the alarms off for today because I need Tommy to get used to wearing it first, alarms later. (He said that on trial #2 of the Guardian RT the alarm went off several times in school and it was a little embarrassing.) This process is definitely on a learning curve just like everyone told us!

Our Medtronic Rep. is coming to Tommy's school today to talk with Tommy and the school secretary. Tommy really likes her, so I think that it will help.

Wednesday, March 22, 2006

We tried again!

Jenny says:
Well, we took a little break since our last attempt to insert a sensor. Last night I asked Tommy if he was ready to try again, and he said that he was! We decided to try manually this time rather than with a Sens-serter. It went better. I think a lot of people like the inserters better than manual insertion, but for us we feel that it is easier to get a consistent angle. It seems less likely to be surprised by a painful insertion. Tommy is unusually thin.

I decided to insert another sensor into my skin just to see what it felt like with a manual insertion. I think it helped to have him see me do it. Both of us had a lot of trouble breaking the skin. I believe that we were inserting too slow. Once I went quicker, it went in very easily. Tommy was very hesitant, and wanted to give up. I had to tell him that we weren't giving up, and that we were going to get one of these in him tonight. He ended up poking his skin several times before he successfully inserted one into his tummy. He went to bed feeling a little dejected. I told him that we will try a few more times before we make any decisions on whether we keep using it or not. I just wanted to cry.

Our mini-med rep. told us in the beginning that it was a four sensor learning curve. I do believe that it will be easier the next time now that we have a strategy of how we want to get the sensor in there.

Thursday, March 09, 2006

Painful sensor insertion

Jenny says:
We got a little busy since the last sensor was in Tommy, so we didn't try to insert a new sensor until tonight. This was our first one all by ourselves and it did not go well.

I decided to try it tonight because the kids don't have school tomorrow. The manual says that it is better to insert in the morning because you need a steady blood sugar two hours after the sensor insertion and then another steady one 6 hours after that. But we never woke up in time to do that before school this week. Plus he would have to enter some figures into the monitor while he was in school. I didn't think he was ready to do that on his own yet. I think I better try a few week-ends first when I am with him. (Summer would also be a good time to try this.)

Well, I decided to try tonight and then just wake up two hours later to calibrate it. We numbed the two spots for 30 minutes. Then he took a shower, he needed one anyways. His pump insertion went fine, as always lately. Quick and easy. Then we came to the sensor.

He had told me earlier, that he did not want to wear it, but I told him that he had to give it another try. It has been a little complicated that we don't have to wear it, like with his pump. That is a good thing, and in this initial case a not so good thing. I think in his mind, since he isn't very fond of it yet, he hopes that I just forget about it. So he puts up a little resistance. I will definitely not make him wear it all the time if that is what he chooses. But I feel that we should probably try it 5 or 6 times before we come to any real conclusion.

He tried to put the sensor in with the automatic inserter. It must have been too steep of an angle. (We had this same problem with the Silhouette inserter.) He immediately began to cry. (Being 9:30 pm didn't help either.) I believe that it went too deep. Maybe hit some nerve endings. It didn't bleed. We slowly took the whole sensor needle back out. I gave him a hug and told him that we would wait until after his basketball tournament this weekend.

I called minimed and they gave me some pointers about how to angle the inserter so it is not so steep. Also, they recommended that I try to find a spot where I can "pinch an inch" on him. Those spots are limited. They also said that they would give me a credit for a sensor.

I'll write more on the next sensor insertion try.

Sunday, March 05, 2006

Changes needed after seeing graphs
Jenny says:

O.K. It has been an interesting couple of weeks. Our Medtronic Rep came out to do our first home sensor change. Tommy inserted the sensor into the fatty spot on his back above his hip. That was a huge accomplishment for him. He does not like to move away from his stomach. We decided to put a piece of IV 3000 UNDER the transmitter because Tommy's skin really reacted to the tape from the transmitter. It got really red and bumpy. I tried hard not to ask Tommy to see his numbers when I was simply curious. I behaved. We both made more of an attempt to enter the insulin events and the food events into the Guardian, but there is still room for improvement. And we figured out how to keep it on for longer, so we elimated some of the breaks in the lines of the graphs.

I have been careful not to jump to any conclusions about whether I like the Guardian or not because I have been warned that it takes time to adjust, just like with the pump. We also don't know how often he is going to wear it. However, I just analyzed Tommy's second three day period and I learned a ton about how Tommy's body really works, (for now.) I love this thing. (Tommy has not fallen in love with it yet. I'll keep you posted.)

After carefully studying his graphs, I now know that he is not getting enough insulin around 10:00 pm because he starts to go high at 12:00 am every day. My husband and I typically test Tommy at 1:30 a.m. and 4:45 a.m. Our pokes were missing the highest part of the peak at around 2:30 am. So, when Tommy does not have the Guardian on, we might change the time of our nighttime checks. I bumped up Tommy's basals from 10:00 pm - 2:30 a.m.

We also have to do a better job of giving the insulin a few minutes BEFORE meals with Tommy. The graphs showed a few peaks past 300 after breakfast and supper which I never caught because he finger sticks usually 2 1/2 hours after eating.

After seeing the data, I have set up a weekend pattern with his basal insulins. It is pretty apparent that his needs change when he sleeps in and moves around more during the day.

One of our future strategies with the Guardian might be to wear it one weekend a month and one weekday shift per month. That way I can make some monthly adjustments. I'm not sure yet how often Tommy will wear it. (If it were up to me, it would be 24/7.)

Friday, March 03, 2006

Small Life Style Changes

Jenny says:

A. Wearing the monitor
The monitor is bigger than an insulin pump, so I think it takes a little getting used to wearing for a 60 pound kid. But on the 5th day of keeping track of the Guardian monitor, I think he is finally used to it. For the first few days, I was trying to keep it on something nearby like a chair or table so that I didn't have to bug him if I wanted to see the numbers. But he never stayed in one place for very long and he often didn't remember to bring it with him, so it would alarm frequently and then I would have to go and find him. (Once the monitor can't find you, it alarms until you find it.) The monitor and the transmitter also have had some trouble communicating at night if Tommy rolls over a certain way or is bundled in lots of covers. So, we have decided that when Tommy is wearing the Guardian, it is either in his pocket or clipped to the waist of his pants. When he is sleeping, I have found that when I lay it on the bed next to him rather than on his night stand it still can find him, and I can take a look at the numbers or turn off an alarm without waking him up. (The alarms wake me up before they wake Tommy up. Heavy sleeper. Supposedly, if we were not to wake up and clear the alarm, it just keeps getting louder and louder.)

We look forward to the Minimed Pump 522 that will eliminate wearing this bulky monitor.

B. Calibrating the Guardian in Steady Waters
From Wil's blog (www.lifeafterdx.blogspot.com) and the Guardian literature it is explained that to get the numbers on the Guardian monitor to be as acurate as possible, it is important to calibrate the Guardian with numbers from a finger stick that was taken in calm times. By calm times or "steady waters" they mean that a number is not moving up or down very rapidly and that the number is neither very low or very high. (Even meters aren't that accurate when at those high levels.) We sometimes have trouble finding numbers that aren't quickly moving up or down. We learned a few days after wearing this Guardian that you need to enter a steady number at least 15 minutes before eating or giving insulin. You have to do that at least once every 12 hours. It has taken an extra thought to remember to calibrate.
C. Finger sticking
Ideally Tommy should do a finger stick test 15 minutes before he eats so that he can use it for a calibration check and to help him figure his meal bolus amount. This seems to take a little more thought than what we were doing. He was usually testing after the first few bites of his food.

Tommy has currently reduced his finger sticks by 2 or 3 per day. He is still poking before meals and at low/high alarms. I believe that as time goes on, we will be getting less low/high alarms and sometimes using the Guardian # to bolus for a meal; therefore, reducing finger pokes even more. The numbers seem relatively trustworthy so far.

D. Double site changes
We have so far decided to change his pump and the Guardian on different days just because it still seems so complicated. The Guardian literature says that it would be best to put it on in the morning. Tommy has only put two sensors in. I am hoping that it will soon become uneventful like when he puts in his pump site. Maybe then we will do them at the same time.

E. Entering Events like insulin and food
On the monitor, there is an option to enter an event like insulin, food, exercise, etc. This is very nice because when you look at the graphs in the Solutions software it helps to see when these things happened and what the sugars looked like hours afterwards. Since Tommy hasn't really seen the graphs yet, he is not very motivated to take the extra time to enter these events into his Guardian. (He is usually already entering data into his pump at these times.) So the data when at school, I have to get from the Carelink software from his pump. (This problem will also go away with the 522 pump because the finger stick checks will go straight to the pump without Tommy even pressing a button. Also, the 522 people will be using only Carelink software which will combine information from the pump, the sensor and the meter.)