Opsite Flexifix

For the first time since Arden began wearing a CGM we are using a third party product to aid with adhesion. Back in December I realized that the adhesive on the new DexCom G4 sensors wasn't as resilient as it was on the prior version of the device. I tried for a few weeks to be sure that we weren't just having a bit of bad luck, but after a few attempts my suspicions were validated. As others started to experience the same lack of longevity the Internet became littered with folks saying that the new DexCom G4 adhiesive just doesn't stick like it did with the 7+.

I knew instantly that I wanted needed to add a third party product into the mix and I began to search online for options. All of my research led me to want to try Opsite Flexifix first so I ordered a roll on Amazon and waited for the UPS driver to arrive. 

I later found a post on the D-Mom Blog that explains, step-by-step, how Leighann prepares her daughter's Flexifix to work in conjunction with a CGM sensor. I co-opted Leighann's plan for how she cuts the center hole and made one small change. Instead of a significant overlap, I cut the Flexifix just slightly larger than the DexCom's original adhesive (image below).

Tomorrow will the twenty first day since the sensor above was applied.

Opsite Flexifix, write it down.  

Update on Thursday, February 7, 2013 at 10:16AM by Scott Benner

Here it is Shelley.

I was Just Talking to Chris

I spoke with Christopher Snider, host of Just Talking Podcast last night for over an hour. We talked about movies, blogging, diabetes, being a type I CareGiver and my new book. 

Chris is a fantastic host and his questions felt very organic, like I was chatting with a someone that I've known all my life. There were moments of real honesty, I cried a little bit when I was explaining why I blog about diabetes though I'm not sure if you'll be able to tell... I covered my mouth.

I'm so interested to listen to the episode because I've been having difficulty explaining my book, a difficulty that I find very frustrating. I spoke previously about experiencing awkwardness when I try to give a quick synopsis of Life Is Short. I'm finding that when I have time to speak at length about it I make out just fine, but when I'm asked to be brief, I can't seem to find the words. I struggle to find a way to condense how I feel into a sentence or two. I think that you'll hear that when you listen to Just Talking. 

I continue to be unable to identify what my mental block is. Some days I feel like I don't want to short-change the book by saying something like, "it's stories from my life", because it's much more than that. I can't tell you how confusing it is to have written a book that I'm so proud of and not be able to say what it's about or understand why I'm blocked from being able to do so. Maybe the text is just so personal that I don't feel comfortable defining it. I'll figure it out, and if for some reason I can't, I'll be happy to let your reactions to the text speak for me.

I guess that I won't be too quick to make fun of an actor the next time I hear them say, in an interview, that they can't describe their movie because it's too personal. I think that I actually understand what they mean by that... Perhaps it's a universal feeling. Maybe when you create something and put it into the world for consumption it ceases being yours to define. Maybe now that I've finished writing Life Is Short it belongs to you?

My weird issues about writing aside, most of today's episode with Chris is centered on diabetes, blogging and being Arden's dad. I hope that you enjoy it. If you have time, please leave a comment and let me know your feelings on the interview. Obviously I have no idea how it went. :)

Episode 173 - 1:06:28

Stream online at http://justtalkingpodcast.com

Download the MP3

Listen on iTunes

On Stitcher

Just Talking Archives

Basal Adjustments

I was asked on FaceBook to explain how I made the adjustment to Arden's overnight basal rates that resulted in the graph above. I'm sorry that it took me so long to write about my (less than technical) process. Here's how I did it...

Somewhere around the second week of overnight lows it became obvious to me that I was dealing with a trend and not an anomaly. Something had changed about her physiology and I was going to have to adjust - basal adjust.

I'm not going to lie, I didn't do any basal testing. I have the procedure around here somewhere, the page or so of directions from Arden's endo that explains how to do basal testing - but I tried a more, let's say, personal approach. Luckily CGM technology lends a distinct advantage and unless we are averting a low, Arden doesn't eat at this time of night so trend graphs are a perfect way to understand where we have too much basal insulin.

I broke out the stupid PC laptop that we had to buy, because the damn device manufacturers refuse to port their software over to OS X (Apple), then I downloaded Arden's DexCom data. It only took a moment to see what time of night that her blood glucose was drifting lower.

Arden's overnight basal rate was .30 per hour, all I did was dial it back to .20 starting one hour prior to when her BG was beginning to fall, not terribly scientific I know. The possibility that this adjustment would be too little or too much wasn't a huge concern, because let's face it, I'm awake anyway.

As you can see in the image above, the slow drift that was beginning around 4 am leveled off nicely. The picture you see here shows that there was room for a little more basal insulin. I waited two more nights to verify that this graph was accurate and then I moved the basal to .25 an hour. That adjustment caused a slight dip and so the next night I staggered the hourly rates .20, .25, .20, things have been golden since.

The reasons that I like handling basal adjustments myself are simple. Waiting until Arden's next endo appointment to discuss this doesn't feel like an option - too long. Continuing to live with lows would have not only taken the rest of the precious little energy that I have left, but also it would leave Arden in danger - not doing that. People living with diabetes will always need to make adjustments like this. Their bodies, like everyone else's, are constantly going through ebbs and flows. My pancreas doesn't secrete the exact same amount of insulin every hour and it makes sense that Arden's pump shouldn't either. Arden's body has needs, ever changing needs - I have to keep up with them.

We all have to be comfortable making decisions like this autonomously at some point. As parents we don't always have the time to call for an army of help and our children's bodies shouldn't have to wait days or weeks for balanced control. Don't get me wrong, I wouldn't make a grand change to Arden's care without our doctor and I don't chase every night that doesn't go perfectly, but basal adjustments when they obviously are needed... We can do that!

If you are going to make basal adjustments please don't forget to write down your old numbers in case you have to switch back. Actually, if you don't already have that information recorded somewhere, take a moment to do that. Write down basal rates, IC ratios, alarm thresholds and all of the other personally inputted data that your pump and glucose monitors retain, just to be safe.

Later this week I'll be talking about Pre-Bolusing, Arden's latest A1c and more... stop back, like Arden's Day on FaceBook or follow the RSS feed to stay in the loop.

Good luck getting those basal rates where they need to be and then enjoy the huge difference in your BGs!

Life Is Short: Intent meets Doubt

I've painted more than my fair share of rooms in my life and by all accounts, I've done a very good job. The trim is always straight and the walls are evenly covered. I don't skimp on primer and I have decent eye for what colors work where. Even with all of my experience, I'd be nervous to walk outside with a ladder and paint the exterior of my home. A job like that seems too big for me to tackle and I wouldn't want to take on such a monumental challenge unless I was sure that I could deliver a great result.

That's what sitting down to write Life Is Short felt like. I had writing experience even though it wasn't in the form of book writing. I had the determination and I was confident that my story was a fresh look at an interesting, emerging social issue. As I wrote I felt good, the words felt good coming out and the text was taking the direction that I'd imagined. There were benchmarks along the way, my publisher looked at that the first 15,000 words and provided feedback. She made me feel like I was on the right track, her support gave me the confidence to believe in the direction I chose for my first book. I was sure that my intent for the book was materializing on the page, I couldn't ask for more.

When the day came that my manuscript was due, I handed it in with a lightness of heart. The book really did come out the way that I envisioned. I was more than pleased with what I had written but I struggled to hold on to that positive feeling in the days after I submitted the file.

Soon my stress level was through the roof. What if they didn't like it? What if my writing doesn't measure up? Doubt rushed in and clouded my every waking moment. I began to experience a stiff neck and it's grip intensified each hour that I didn't hear back. I couldn't think about anything other then my manuscript. A week later I stopped wishing for someone to tell me that they liked the book, opting to hope for any response, good or bad. I needed relief and decided that it would be better to hear that people hated my book rather than hear nothing at all. I was quickly lost in the mindset of a sixteen year old boy who had just passed a note to a girl he liked. I wasn't able to wait patiently for her reply. Did I make a mistake trying to take on such a big project? Was my house now the laughing stock of the town? I should have stuck to painting rooms.

It is incredibly difficult to put yourself out into the world in a way that invites critique. In this case I wasn't prepared for how crippling it would feel to lay my heart out for all to see. I put so much of myself into my book, told so many deeply personal stories. I needed someone to either circle yes on the note that I passed or send it back so we could get the pointing and laughing over with.

I did not expect to feel so exposed by the process.

Some early reviews have been good and I've received a few wonderful personal messages from folks that are reading advance copies. Responses have been very positive and heart-warming... I am happy to report that I can once again turn my head completely to the left.

I expect that there will be people that won't enjoy my book and that some of them may well take to the Internet to voice their feelings, but I'm okay with that possibility now. This process has given me the confidence to say, and mean, "I wrote a book that I am proud of, some will love it, some will like it, a few may not - but I know it is good. Felt good coming out and I should have trusted that feeling".

Looking back I see that I couldn't help the doubt, but it didn't emanate from insecurity the way that I initially imagined. My fear was rooted in a desire to please the reader, to please you. I can see now that I care deeply if you enjoy the experience when you read. My fondest desire is for you to leave the text richer then when you arrived... nothing else matters. Today I'm confident that can happen. I'm no longer nervous, that terrible feeling has been replaced by excited anticipation. Look for my next entry, Life Is Short: Amazon sometime soon.

Life Is Short, Laundry Is Eternal will be in stores on April 2nd but you can Pre-Order today.

Why does basketball make Arden's BG rise?

Arden brings the ball down the court, passes and looks for a rebound.

Last week during Arden's quarterly Endo appointment I brought up an issue that I had identified but couldn't figure out. I explained to our nurse practitioner that when Arden exercises her BG falls. Riding a bike, running around, recess at school, really all of the her physical activities decrease her BG... except sports.

I, of course, am aware that activity can cause a decline in BG but our issue didn't seem to be following that "rule". It took me a while to be able to see past the expectation that physical exertion would decrease Arden's blood glucose level. Inexplicably, I was having trouble with her BGs actually going up during basketball games and practices this winter. When I finally thought back, I realized that I saw similar BG trends last summer during softball.

Our NP asked about Arden's level of competitiveness, as she spoke I began to understand what she was getting at...

Arden is a very competitive little girl, when it counts. That is to say that if she goes out back with her brother to shoot baskets her BG falls from the activity as you may expect but when she is in a game, when there is a score being kept and winners and losers are recorded - Arden's BGs go up.

I explained to our NP that Arden entered her last basketball game with a BG of 125 and that by the end of the game, just one hour later with no food or carbs in her system, her BG was 220 and climbing. I was bolusing during the game, which was nerve wracking when you consider that the expectation is that there will be a fall from the activity.

The NP described to me that this is a phenomenon that they generally see with boys, then she turned to Arden and said, "so, you like to win huh?". Apparently it's common for very competitive people to access their flight or flight response (also known as 'the stress response') during a sporting competition. Their desire to win is so strong that they feel the game on a different level. Adrenaline is released and their body prepare to battle as if they are fighting for their lives.

Next week when we arrived at the gym. I am going bolus as if Arden was about to consume a 15 carb juice box (the ones we use for low BGs). I'm confident that the insulin begins to act it will find a rising BG to tussle with, if I'm wrong... we'll just drink the juice. I'll report back and let you know what happens... Never a dull moment with type I diabetes.