This Picture Makes Me Smile

Do you see Arden in the middle of the purple glowing smoke, the one wearing the hat. Arden danced the night away on Saturday during her first Bar Mitzvah without a care in the world. I just wanted to take a second to tell everyone how grateful my family is for the technology that makes moments like this better. Without Arden's DexCom G4 I would have interrupted her fun countless times during the evening. Each time taking her from the moment and drawing attention to her diabetes. Instead, we were able to monitor her post meal BGs from across the room and when she did require a bolus of insulin, I never took her OmniPod PDM out of my pocket. 

Wireless. Tubleless. Goodness.

Knowing that Arden was safe, carefree and completely unencumbered by diabetes while she danced is a feeling that may be lost on other parents, but I think that every parent of a child with type I will look at his photo and smile along with me. As a father, I found this moment to be completely joyous - nothing beats seeing my kids live without limits.

Have a great week!

Scott

New OmniPod Wherefore Art Thou?

I can remember bugging my parents unmercifully one Christmas for the Omnibot robot from Tomy. I couldn't think of anything else in the months leading up to December 25th. I was hooked the very first time that I saw the Omnibot commercial on television... my wildest dreams were about to come true!

I feel like that little kid again today as I patiently wait for the new OmniPod to arrive at our front door.

Insulet's phone message: It's not super cool like the commercial you just watched but Insulet has recorded an audio message for their customers. You can hear the message at my link or by dialing (888)-7-GET-POD.

Questions about the new OmniPod

I'm sure you've noticed that some people are beginning to receive the new OmniPod. Arden hasn't received hers yet, but as soon as she does I'll begin to make notes about our experience so that I can pass my thoughts on to you.

Until that time, and let's hope it's soon... if you have any questions about the new OmniPod that you would like me to address please leave them in this discussion thread. Hopefully, I'll be answering them before Christmas.

Wierd side note: I knew that I wanted to write about my desire to own the Omnibot robot as a child. When I began to consider this post I, no lie, I couldn't remember the name of the robot - only what it looked like. After some Googling I found an image and couldn't believe that my robot, from all of those years ago, was called the Omnibot. That's the kind of stuff Alanis Morissette writes songs about, don't cha think?

Update on Monday, March 18, 2013 at 9:40PM by Scott Benner

My new book, "Life Is Short, Laundry Is Eternal' is available now - Amazon/Kindle - Barnes&Noble/Nook 

Wrong Button

I learned a valuable lesson about diabetes blogging a few years ago. One of my readers told me that there are times when reading caregiver blogs can make her feel like a failure because so many of them only talk about what goes right... I try not to do that anymore.

The other night, for the first time in over six years, I pushed the wrong button. As you can see on the DexCom graph above, Arden was having a bit of trouble with lows after she went to bed. I was able to avoid waking her prior to midnight by shutting off her basal insulin for 30 minutes. When her BG began to fall again sometime around one in the morning, I decided to restrict her basal once more, this time for one hour.

I've looked at the menus a bunch since this happened but I still can't figure out how I made this mistake, but I certainly did. To make matters worse I didn't hear the DexCom alarm until around five in the morning. When I walked into her room and picked up the Dex, I couldn't believe what I saw, "INSULIN DELIVERY SUSPENDED". I somehow shut off Arden's insulin delivery instead of setting a temp basal. I don't know how. I felt sick when I learned what I had done.

I immediately turned her insulin back on, tested and delivered a bolus. Then set a positive temp basal to aide the situation. It took almost four hours for me to get her BG back to where we want it and Arden was two and a half hours late for school. 

I think that it's very important that we all recognize and accept that we can't be perfect all of the time and that we are going to make mistakes. This one was just my most recent. Please try not to beat yourself up too much when something like this happens (I know you will), you're doing a great job and you're doing so under difficult circumstances. I'm very proud of you, be proud of yourself.

I pushed the wrong button.

Update on Monday, March 18, 2013 at 9:43PM by Scott Benner

My new book, "Life Is Short, Laundry Is Eternal' is available now - Amazon/Kindle - Barnes&Noble/Nook 

Video: Behind the New OmniPod System

Insulet has released a promotional video describing their new OmniPod.

I hope that Arden's arrive soon, I can't wait to see her with a smaller pod.

Pre-Bolus

Original art by Mike Lawson - Check out Mike's YouTube page by clicking on the image

This story begins in 2006 just moments after I asked Arden's nurse practitioner if she was "nuts".

NP: <blank stare>

Me: <incredulous gaze>

Only moments before our staring contest began Arden's NP became the first person to suggest that I give Arden her mealtime insulin before she started to eat. I can't be sure if she referred to the practice as pre-bolusing, probably not as we were MDI, but she definitely wanted me to inject before Arden ate.

"Are you nuts?"

I responded emphatically that I could never give Arden insulin before she ate. Arden was two years old and there was no way to be certain of how much food that she would finish. The NP repeated her very reasonable request but I could not wrap my head around this new idea. Pre-Bolusing, bah, Arden would be safer if I left her alone at the mall with money pinned to her shirt.

I was 100% correct on that day. There was absolutely no way to be sure of Arden's appetite. However the inability to guess how much she would eat wasn't the only reason I didn't want to inject before meals. Arden weighed maybe nineteen pounds at the time and Novolog had a way of peaking intensely in her body. She had already experienced a seizure from an insulin miscalculation that I made. That mistakes lesson was still very fresh in my mind and with that bad memory still looming over me, I just couldn't bring myself to administer insulin that wasn't already covered by food or a high BG.

Of course everything that the NP said made total sense. I wanted to give Arden's insulin a head start, I dreamt of a moment when her food would begin to expel it's carbohydrates just as the insulin was pulling her BG lower. I could picture that perfect image in my mind, a tug-of-war with food on one side and insulin on the other. Both combatants pulling furiously without once moving the rope that is Arden's blood glucose value - the dream of a steady mealtime BG. I wanted very much for that to be our reality and so I promised myself that I would make the adjustment when the time was right.

Fear and poor timing stopped me from taking the NP's advice all those years ago. Eventually the day came when I found my footing with the idea and gave up on being scared... that's the day Arden's A1c began to decrease.

We haven't looked back.

The beginning of our trip down the road to pre-bolus freedom was littered with pot holes. The first bump took some time to traverse, we first had to wait until Arden was old enough to give thoughtful consideration to her hunger. After that hurdle was cleared we took the first step, bolusing ten minutes before a meal. Those next ten minutes were the most tense of my day, I would test and worry so much after the bolus that I barely had time to finish cooking. Initial results were less than stunning so I moved the pre-bolus to fifteen minutes before a meal. The extra five minutes increased the impact of the insulin and lessened Arden's post meal spikes, but I still wasn't seeing a huge return on our efforts. I wanted to take the process to another level but I couldn't, in good conscience, give Arden insulin farther from the beginning of her meal. If only I could see the insulin work, I needed a crystal ball...

... or a DexCom CGM

Arden's CGM turned pre-bolusing into the most valuable weapon in our arsenal. It's one thing to have a good idea of how long it takes insulin to begin working in the body. But when you are able to not only witness the movement of the BG, but also the speed with which your glucose level is rising or falling... it's the difference between rumor and fact... between guessing and knowing with reasonable certainty. The day that my eyes were opened to the benefits of wearing a CGM, that was the day that everything changed.

Arden was 149 before dinner last week. I bolused for the elevated BG and pre-bolused for 50 carbs, it was a significant amount of insulin for her. Before DexCom I would have panicked and served the food in less then ten minutes. Now I take my time finishing dinner while Arden and Cole do their homework and leisurely prepare their plates as I wait for the CGM to tell me when to serve.

I put dinner on the table when the arrow on Arden's DexCom G4 turned south, waiting until her BG was below 110. The amount of time between Arden's bolus and her BG decline can vary most days depending on a number of factors. Glucose monitoring grants the flexibility to wait, providing a level playing field for the insulin and those scrappy carbs to wage their battle on.

At least now it's a fair fight.

Don't forget what the bottom of the site says... Always consult your doctor before making changes to your health care. I am not a doctor.

More about the art: The art work displayed at the top of this post is an original piece from Mr. Mike Lawson. Mike is a tireless advocate for people with diabetes, a friend and extremely talented artist. You can find him working at TUdiabetes, on Twitter and through his fantastic YouTube channel.