Here’s some old pictures that I posted before of the sensor, transmitter, and needle itself. This post is more about the actual menus on the Paradigm 522. This isn’t the sensor that’s working so well. That one is on my butt. And I’m long past the age where posting a picture of your butt on the internet is considered acceptable.

Just the sensor. Yes, that’s blood. No, it doesn’t hurt.

Sensor connected to the transmitter with some bonus pump tubing:

After this, you generally cover it with IV3000 or Tegaderm.

The introduction needle:

Here’s the 3 hour view:

The line represents my lunch bolus. I spiked, but I’m dropping again now, probably too quickly for how much insulin I have on board, but since I have gastroparesis, I’ll likely get a second spike before I drop too far. The 3 hour view allows you to scroll back and see your sensor readings every 5 minutes.

Here’s the 24 hour view:

Again, lines are boluses, the dark area is 6pm to 6am. From this view you can see the sensor reading every 20 minutes if you scroll back. The top dotted line represents 180. The bottom represents 75.

Sensor Alarms:

I have a lot of lows at night it seems, and I just can’t resolve them. My rates during the day go up to 1.1 units/hour. At night I’m as low as 0.3. I think I need to turn down my basal earlier in the night. Fortunately, even though I’m not waking up, my body seems to do a good job of recovering me from these.

This is the sensor menu. Enter Meter BG is used to calibrate. Sensor update history shows you the time and number of each calibration you’ve done. Sensor alarm history can be seen in the previous picture.

This is the next part of the sensor menu. Sensor start allows you to start a new sensor (or find a lost one). Sensor set up is where you edit settings.

And here are the settings you can edit:

And finally, the status screen (escape 4 times from the main screen on the Paradigm 522).

The Isig is, as I understand, the actual electric value coming from the transmitter. This is used to calculate the glucose value with a formula that changes each time you calibrate. But I could be totally wrong, so don’t quote me on that. But anyways, it’s there. It needs to be between 2 and 100. Above 20 and below 7 are generally bad news for your sensor’s health, though.

I need to calibrate this again before 10:41pm today, or I’ll stop getting readings. You can only calibrate when you are stable. There can’t be arrows on the screen.

The sensor time on this is wrong, since I have already restarted in 4 times, I’m actually on my 14th day with it. I love when things work well. I’m sure it’s not good for my subq tissue, but it sure does save money. I look at it everyday, and it seems to look okay and I can’t feel it at all.

The rest of the status screen:

Scrolling down further would just give you my serial number, which, so sorry, I’m not posting for all the internet to see.

A lot of people ask me if using the sensor has cut down on how often I test. The answer is yes and no. I really haven’t cut down on how much I’m testing overall, but it has prevented me from testing in situations I might have otherwise and allowed me to be safer about not testing in situations I wouldn’t have tested in even before.

For example, today I had a small snack after some shopping time. I probably wouldn’t have tested before it anyhow, but my sensor said I was 82, so I didn’t bother bolusing for it, when I probably would have before.

Also, when I wake up at night, I often test. Now I just look at the sensor screen and decide from there if it’s worth waking up enough to actually test.

It also has brought up some enlightening, though frustrating, patterns- when it’s properly working, that is.

And that, concludes my quite long and rather time consuming CGMS tour for today.

And that, concludes our photo tour.

Then it hit me why it’s so utterly annoying. The expectations just aren’t clear. I have no clue what is expected of me or how to get a good grade or better yet, how to get a lot of the work out of the way so I can have clear sailing the rest of the semester.

Instead, I have the professor who wants us to do service hours and journal that. And the art teacher who only grades a “little” based on actual artist ability. And the professor who told us his final will be a surprise and the easiest and hardest final we’ve ever taken at the same time. And the professor who “just wants us to have fun.”

I am sure there’s some deeply philosophical meaning they’re trying to teach us to life. But I’m not interested in the meaning of life. I’m interested in getting these electives out of the way, possibly getting good grades, and hopefully graduating in May and getting those precious letters “RN” after my name.

Sorry the quality is so poor. My good camera is at home, and my backlight isn’t working for reasons that will be blatantly obvious to any Minimed user. First day back to school has had me stressed and resulted in bad blood sugars anyways.

In good news, this is day 8 of sheer accuracy.

We continue on the month by seeing the Omnipod will work with Dexcom.

And today we find out the Animas will work with Dexcom as well.

Since Minimed already works with it’s own CGMS, this just leaves Cozmo. Though I suspect, not for long.

Folks, I think it’s going to be a good year for CGMS.

*ring* *ring*
Me: “Hello?”
Them: “Hi, this is the doctor’s office. We have your blood test results- everything was normal.”
Me: “Good, what was my blood sugar.”
Them: “Oh, you’re way too young to have to worry about that.”
Me: “Actually, I’m a known diabetic.”
Them: “Well, it was normal.”
Me: “I want to know the actual result so I can see if my meter is accurate.”

Feh- this shouldn’t be like pulling teeth! I’m just glad that they called with the results. I always like the gesture.

Lab: 83
Meter: 78

I’ll take it.

Me: “Hello?”
Them: “Hi, this is so and so from your insurance company.”
Me: “Ok…”
Them: “Does anyone in your house have diabetes?”
Me: “Yeah, I do.”
Them: “Do you have a glucose meter?”
Me: “As a matter of fact, I do.”
Them: “How old is it?”
Me: (I have no clue) “About a year.”
Them: “Did you know you’re eligible for a new glucose meter every year?”
Me: “Ok, but I really don’t need one, I can get one whenever I want. My doctor’s office gives them out.”
Them: “Ok, well they can lose accuracy after a year, so ask your doctor for a new one.”
Me: “Ok, have a good day.”
Them: “You too.”

They really don’t know who they’re talking to…

Thank you, insurance company, I don’t know what I would do without you.

And that’s said tongue-in-cheek because I really don’t know what I would do without them, though not in that sense.

And if anyone needs a meter, dropped me an e-mail. I share.

My understanding of why devices may not be as nice as an iPod however, does not prevent me from wishing for a few things this year in the diabetes-technology-world.

The first area that really needs to be addressed is diabetes software. Sorry guys, but this is pathetic, and definitely an area where every single diabetes company out there can take a lesson from Apple. I’m honestly of the belief that I should not need to log manually.

First of- please, don’t charge me $40 for a cable just so I can use the software. That’s ridiculous, and I know that cable didn’t cost you that much.

Secondly, why when I have a pump that tracks all my insulin use and a meter that stores all my blood sugar results, do I still feel the need to log by hand? Oh yes, because your software sucks!

I actually currently do use software to log- but it was developed by someone who’s life was effected by diabetes, not by a company. It still doesn’t offer all of the features I’d like, but it’s damn close. And I have to manually enter readings because it can’t upload from any meters.

Since Lifescan’s Ultra2 and UltraSmart meters allow you to mark a reading as before and after meals, I can get an accurate lay out of the single log-style I like best:

However, this still has flaws. For example, if you test more than once in the same time frame, it creates a second day with the same date instead of just adding another reading in the same box.

I don’t think it’s asking too much for pumps to allow us to mark a reading as pre or post meal on screen, and be able to label a bolus with the proper meal/snack name to create a similar report to the above one, or to simply aggregate the data so I can have a report like this:

My understanding is that the Omnipod software can do this.

So here are my wishes for the new year:

Better software overall, for meters & pumps, and that functions on a Mac too, would be great. I’d like to see the above reports, standard deviation used more, a specific Carelink report that details insulin usage as well as my pump does. I’d also like Carelink to allow you to manually enter a bg. I’d like to see meter connection information opensourced so that independent developers can work on better software. If I upload a meter and a pump, I’d like it to detect and delete duplicates.

It would obviously be best if you could mark a reading as before/after a meal right on a pump or meter, but at the very least, let me change it once I upload it.

I’d like to see the next Paradigm pump smack Active Insulin on the status screen, add a temp rate/suspend history, and add a bg history. And please let my pump stop vibrating. at. every. step. of. programming. a. bolus. I love how easy from the bolus menu it is to select manual or bolus wizard bolus. I’d like to see a similar set up in the temp rate menu- let me choose as I’m programming the rate units/h or percentage. And let me choose on the Easy Bolus if I program in units or carbs.

My understanding is that the Omnipod also doesn’t show active insulin on the status screen. I wouldn’t be surprised if we see Omnipod shrink the pod size. I’d definitely be more willing to use it if they did.

I’d like to see the Cozmo pump have a way to turn the backlight on from any screen and turn it off from any screen. I’d like to see it automatically not show homescreens that aren’t relevant to what is going on at the moment (ie, no temp rate home screen if I don’t have a temp rate active). And while we’re on the temp rate screen, I’d like to be able to see the temp rate in units and percent. I’d like to be able to program the temp rate in u/h or percentage, the bolus by carbs or units without having to change a setting. I’d like to have the choice as to whether the touch bolus increment in units or carbs. I’d like the bolus calculator to show how it did the math better. And let’s not forget that every Cozmo user out there is begging for a better clip that works with the Cozmonitor.

As for meters, I suspect 2008 will bring more that don’t require coding, and I’d like to see more that allow you to mark a reading before/after meal on screen. I’d like to see more with backlights and strip lights. I’d specifically like a Freestyle meter that let’s you tag readings. I’d like to see the Ultra series have a strip that takes less blood and get strip lights. I’d like to see an UltraSmart2 that does Standard Deviations, has a carb database, and let’s you record square and dual wave boluses, temp rates, and your actual basal on the meter. Of course all this will lead to easier record keeping. I’d like to see more “on screen” reports. I’d like to be able to see an average of all before meal and all after meal readings on the Ultrasmart and range info for “all readings” on the Ultrasmart. I’d like to be able to choose to flip through all readings, just before meal readings, or just after meal readings on the Ultra2. I’d like to see a Bayer or Accu-Chek meter with a backlight. I’d like to see the Contour2 able to use the before/after meal tags for averages.

I know many people that wish for bigger font on their meter/pump.

I’d like to see more syringes/pens with half units and more pens with larger memories. Even a pen with a bolus calculator would be great.

I’d like to see plungers on syringes be a different color from the markings on the syringe.

I’d like to see more “wireless” devices, such as better remotes for pumps, and remote speakers that will actually wake me up if my CGMS says I’m low at night. I’d like to see more devices that allow parents to see their diabetic child’s blood sugars while they are at school.

Who doesn’t want to see improvements in CGMS and insurance coverage for such in the new year?

I’d like to see more meters coming in fun colors.

None of this should be construed as complaining. I always wonder at how much technology is out there and how far we’ve come.

Overall, many of the features I want can be summed up as better integration with each other and more thought to flexibility for the user. And Amy is right to a T (pun intended) that Apple is better at that than any medical company.

Though I can’t get my iCal address book on my phone. But we’ll blame that on the phone, since it went on my iPod just fine

I’d love to hear your thoughts on nuances of living with diabetes and how technology can change it.

My favorite part of Christmas by far is going to church Christmas Eve, lighting candles for the finale of Joy to the World, and then raising them for the last verse. It really gets me in the Christmas spirit, as the final hours before Christmas sneak away and the emphasis is on the real meaning of Christmas, good company, and Christmas carols.

I love watching the candle light seep up unevenly through the pews, and anxiously anticipating when my candle will be lit. The pyromaniac in me loves the fire. I love how pretty it is when all of the candles are lit and held up for the last verse, a sea of flames giving praise to The Saviour.

But my favorite part this year, by far, was when my sister said to me at the end of the service, “You were right! We sang “Joy to the World” when the candles were lit!” totally unaware of the tradition.

Merry Christmas everyone!

In terms of the rest of the GI visit, my blood sugar was low when I got there, so I had to explain why my heart rate was 120 when they took vital signs. I still love my gastroenterologist. I still have really bad (or “significant pathological”) reflux disease. They might want to take my gallbladder out despite multiple clear ultrasounds, because apparently the fact that Carafate helps my symptoms suggests some bile reflux. They doubled my domperidone (to 20 mg 4x/day), and in 6 months when I go back they may consider repeating the gastric empty study to see if I really have gastroparesis. If I don’t, they’d recommend a fundoplication. If I do, no go on the fundoplication due to risk of gas bloat syndrome.

And I’m sorry if I just bored everyone to tears and sent you all to Google. I’m too tired to link. Google any of those for extensive levels of TMI.

Overall, I’ve heard the horror stories and the miracle stories on Fundoplications, but I feel really healthy right now and therefore feel no need to go through invasive surgery.