Tuesday, November 9, 2010

Doctor report and new tools!

I have been working a lot and have not had a ton of time to keep up on the blog, or ride for that matter! But alas, I have much to tell! Mostly on the agenda is a report about my appointment at the Joslin Diabetes Center with my new CDE (Certified Diabetes Educator). Oh, and also I made a major change in my CGM (continuous glucose monitor) and Insulin pump..... as in I got new ones!

I guess I have a race report too.... from 3 weeks ago! Here is a run down. I got a new frame in the mail thanks to Jamie for a tip on a great deal for a KHS  CX200. Jamie built it up with all his spare parts (thanks dude!), and I raced it the next day at the Minuteman Road Club cyclocross race in Lancaster, MA. The bike rode flawlessly, however it has been determined that my MTB roots led me to believe that lower tire pressure would handle better on the slick grass. The KHS worked great until lap 2 and somehow the tire rolled off the rim after getting rubbed by another rider and, or, some bumpy corners and the wrong weight distribution peeled it right off. I enjoyed photography and heckling my teammates for the remainder of the day!

So here's the stuff! I saw the new CDE at the Joslin Dibetes Center on Wednesday last week. It was a much better experience this go around. I didn't have a lot of data for her to look at but we chatted about what my goals were and how/if she could help. It was clear that she was more able to assist in helping me achieve some of my exercise goals, and also suggested seeing the exercise physiologist they have on staff next time. We got all my prescriptions up to date and faxed, and talked about the data I should bring next time so we could get more in depth with my insulin pump and CGM settings. So why didn't I have any data to bring in?

When I go to the CDE or Endocrinologist I bring in reports so we can see any potential trends for high or low blood sugars that might be able to be corrected with some setting on my insulin pump. I didn't have any this time. Here is the short reason. I was on a Medtronic Minimed CGM. I called to order some supplies and was asking about my warranty periods. They told me the warranty was due on my CGM 2 years ago, and that they only guarantee its results for 6 months! Mine was 2 1/2 years old and if you go back and read my blogs you can see how unhappy I was with its results over that last summer! I thought I was doing something wrong and blamed it on everything from the humidity to bad glucose monitors! They had never told me about the inaccuracies after 6 months, nor had they bothered to tell me it was out of warranty when I called each month to order new sensors. This along with other issues forced me to look elsewhere.
After much research I found two new companies. Omipod (Insulet Corp.) is out of Boston and they make my new insulin pump. Dexcom out of California makes my new CGM. I'll say right off the bat that this is a disadvantage compared to the Minimed Real Time Revel system. I now have to carry two devices instead of one! However, they are merging in the very near future and this will be resolved. Also, technically I don't have to carry both all the time. So the main advantage for me going to this system is that there is no tubing! With the Minimed system you are tethered to a 23-43 inch long tubing that dispenses insulin to the infusion set 24 hours a day. With my new Omnipod there is a 'Pod' (pictured above attached to my under arm) that holds some electrical parts and a 200 unit supply of insulin. The pod gets changed out every 3 days and is controlled by a 'PDM' (personal diabetes manager) that is kinda like a cell phone or a Palm type of device. The PDM also has a built in glucose meter, so I don't need to carry one anymore. The PDM only needs to be near me while I am correcting a high blood sugar or eating food that I need to take insulin for (bolus). The pod remembers my basal patterns and can run those programs with its on board memory and pump. So far I am really happy with the pump and pod. It may sound funny, but it is really empowering not to be attached to the cord from the old pump and getting tangled in it everyday!

My new CGM is from Dexcom. It is a little smaller than the Minimed CGM, but the main benefit is that you can wear it for 7 days as opposed to 3 days. It also has a hand held device like a cell phone where I can read the current blood sugar and see other trends and details about my current blood sugar. This will be integrated to the Omnipod PDM in the near future so I will only need the one device to see everything going on. So far (9days) the Dexcom is very accurate. I would say it is more accurate than the Minimed ever was, and I am really happy with my new system. I am excited to see the new PDM that will talk to my CGM, and will struggle carrying the 2 devices in the meantime, but I think it will be worth the wait! Not having the tubing is going to help with my bike riding and racing, I won't get tangled in the night, and.... I never could find a good place to put my old pump when I was naked! Now I can just set the PDM on my nightstand and forget about it!

Hopefully a new race report will come Sunday evening after the Plymouth, MA cross race this weekend!


  1. I would have to imagine that the lack of tubing is a huge advantage for the active lifestyle. If you get a chance, can you write a bit about the challenges of being diabetic and maintaining an elite athlete level weight/body fat index. It seems the glucose intake management would be tough.

    Also, the phrase "I never could find a good place to put my old pump when I was naked!" is a pretty accurate description of my high school and college years. Thanks for bringing it up.

  2. "...and maintaining an elite athlete level weight/body fat index." You funny! Both are things I would like to be better at! I will try to write something up, I think that the way I look at glucose intake is completely different than most cyclists!