CGM impact – is A1C all there is?

Caleb started using the DexCom Seven Plus continuous glucose system in September.  This week was his first endo appointment since starting, a tidy three months later.  I had no apprehensions about this appointment.  In fact, I expected us to be in and out quickly.  We just needed an update to Caleb’s prescriptions in addition to the normal routine.

I was however curious to see what impact using DexCom had on Caleb’s A1C.  His A1C results have always been strong and we seem to keep chugging along.

This quarter’s results were no different.  His A1C was unchanged.  I wasn’t necessarily expecting a change, but I am a numbers and measurements kind of person.  Even if it went up, I could say we were dealing with lows better.  We had introduced a significant enhancement to his diabetes care.  It seemed odd not to have it reflected in “the number”.  If there had been any measurable difference, then I could attribute it to CGM and thus justify its use.  His A1C was not giving me that justification.

So why are we doing this?

My biggest reluctance to starting CGM was asking Caleb to endure more discomfort without realizing a tangible benefit.  He would have to be poked.  He would have to wear the transmitter and carry the receiver.  He would be the one who would be interrupted by all the beeps and alarms.  Of course this is all to improve his glucose control, but that’s not measurable to him.  I would be able to rest a little easier at night.  I would be less stressed when separated from him.  I would be less anxious between finger sticks wondering what was going on inside him.  It seemed he was making all the sacrifices and I was getting all the benefit.  So it would be nice to have something to point to to say yes indeedy, this is worth it – look, your A1C shows it.  There’s no doubt about it.  This was the right thing to do. It’s all here in black and white.

That is not the case.

Caleb’s doctor explained that when you already have tight glucose control, CGM typically will not change your A1C result.  However, the quality of that result is often improved.  In other words, the average of your blood glucose is still the same, but you are avoiding the high highs and the low lows that cancel each other out.  The peaks and valleys are more subtle.  The A1C remains unchanged, but it’s still a “better” A1c.

Hm.  Okay.  So do I believe that is the case with Caleb?  It may be.  I feel like we have caught things quicker and there are less surprises.  We still have highs and lows, but they seem less severe.  I don’t tend to go on feelings though.  I like hard facts.  Embracing this concept, although perfectly logical, isn’t all that easy for me.

After tweeting my concern (and doing a poor job of it because I led people to believe that I was a bit of a lunatic and wanted Caleb’s A1C lower and truly that was not my objective at all) I believe I got the justification that I was looking for. My wise friend, Melinda, helped me get there.  She has a teenage son who has lived with diabetes since he was just younger than Caleb is now.  Talking to her is like taking a magical trip into the future and getting a flavor of what it might hold for us.

I realized, with Melinda’s help, that an A1C isn’t the only way to measure the success of CGM.  From the beginning I have stated that DexCom provided me some relief.  I could see things before my eyes instead of worrying and wondering.  I think I got so used to that so quickly, that I didn’t realize how much of an impact it has.  I know that I am generally less anxious about Caleb’s BGs.  I am wound pretty tightly to begin with, so it doesn’t take much to get me excited.  There is a true, tangible value in decreasing the stress factor.  It’s one that is very important to me.  I know that Caleb has a lifetime of this management in front of him and how I handle it today will impact how he handles it tomorrow.

These are Melinda’s words that eased my worries:

“But HE benefits from having a less stressed-out parent.  They certainly pick up on our cues.  There’s a lot of value in that too.”

I know I do a good job of keeping Caleb’s blood sugars in tight control.  I also know I do a poor job of hiding the impact the out of range numbers have on my psyche.  That is where I need help and DexCom has provided it.

The answer is no, A1C impact is not all there is to CGM.  There is much more. Thank you Melinda and all my Twitter friends for helping me understand that.

“This is Caleb…” – the origin #dblogday

A little over a year after Caleb was diagnosed, when the fog had cleared, we had experienced all our “firsts” and things were more or less chugging along, my attentions shifted.  The present was under control, now what about the future?

I made my first video.  The intent was to bring attention to work being done to find a cure for type 1 diabetes.  It turned into so much more than that.  It entered me into a world I hadn’t realized existed, or at least one that I could be so much a part of.

Caleb, his face, his story, his personality, have all stretched across the world and brought me, and him, within reach of a support system that we would not otherwise have. I am so grateful for this unexpected byproduct.

This is my first work.  When I made it, I could not watch it without crying.  No matter how many times I watched it, I would choke up.  Now when I watch it, there are two things that I note: (1) how much more effective my message could have been had I made it more succinctly (yes, it’s long – sorry), and (2) how my perspective has changed.  The story is still true.  The spirit of the message still resounds.  But now I know the Caleb who has been living with diabetes for almost three years.  He has adapted.  He has flourished.  He has shown me what perseverance is.  Diabetes does not define Caleb. He just happens to be living with it.  I can watch the video now without tears because I know that Caleb.

So, as this and other videos I have made begin, This is Caleb…

At least a part of him.

The results are in…

Caleb Prize
Caleb with his prize as a finalist in Nick's Simple Wins contest - autographed picture of Nick Jonas.

…and Caleb is one of the grand prize winners of Nick’s Simple Wins contest.  The Grand Prize?  Meeting Nick Jonas in Orlando!!

We could not have done it without all of you who watched his video!  Thank you so much!!  In addition to our “offline” friends and family, our Facebook and Twitter friends came through with force and helped him win!  Thank you for watching and posting and retweeting!!

If you didn’t catch the contest video, you can watch it by clicking on the above link (he sounds so funny without his front teeth – a lot happens in six months!).

Here’s the original version we did not submit because the rules strictly prohibited logo usage, but since we are in the middle of the World Series I thought it would be fun to include.  And if you haven’t seen enough of Caleb (which I know you have – sorry) here’s another entry he did just because he’s a crazy nut.

Caleb is very excited.  Thank you for giving this gift to him.  I have no doubt this will be an experience that he will treasure always.

Adapting to CGM

96 Match
OmniPod and DexCom matched up at 96

It’s been almost two months since Caleb had his first DexCom insertion.  Thankfully, the learning curve of CGM is not nearly as great as that of pumping.  Plus, if something goes wrong with the transmitter or sensor or even receiver, there is not as much panic as when something goes wrong with an insulin pump (like ripping it off the first night because you completely forgot about it).  You’re not cutting off life support after all.

So the transition to CGM is much more subtle than the transition to pumping.  That was a relief.

We have had a couple of bumps.  For nights on end, it would just not work.  It literally seemed to go to sleep when Caleb went to sleep and wake up when Caleb woke up.  With some help from fellow DexCom users, that was resolved.  The receiver works great when it’s in the bed with Caleb.  Not so great on the nightstand or windowsill.  We had a receiver go kaput.  We’ve had a couple of off sensors – one just complete fail. DexCom replaced them.

But otherwise.  No real issues.  It’s kind of “plug and go”.  Our training consisted of watching the nurse do Caleb’s first insertion.  Oh, and I read the manual.

CGM has had an immediate impact in several ways.

I was instantly more relaxed.  We had pizza that first night and I wasn’t on edge wondering if I got the initial bolus right or if the extended bolus would cause him to go low.  I could watch the changes in Caleb’s BG as they occurred.  But on the flip side, I get stressed as I watch the BG rise.  And when it continues to rise despite corrections, it’s downright maddening.

Because the blindfold is off, I could see for certain what I always suspected.  Caleb’s blood sugar was often rising significantly within the first hour after he ate.  It came back down at the two hour mark and I saw the happy in-range BG we typically see with fingersticks, but now I knew for sure what was happening in between.  Frankly, it was depressing.  His graphs looked like the lie detector charts of a big fat liar.  I mean, serious pants on fire.  It wasn’t surprising, but there had been comfort in dealing with the ten or twelve points in time and just ignoring the rest.

This new knowledge is power.  I was able to make basal changes or adjust the time of a prebolus making immediate impacts.  Caleb’s chart looked more truthful right away.

CGM provides another form of relief – during the times when I, his diabetes manager, am separated from him.  Caleb has a great support system at school, but now there is an added safety net.  Should he not feel a low coming on, there is a plan B.  Another voice buzzing from his hip that might notice a low before he does.  This applies to other times too – like after-school activities or the rigors of Walking Club before school on Wednesdays.  We have a little more freedom; a little less stress.

In general, there are times where we simply have information that we would not otherwise have; times when we do not have to stop, open up his PDM case and go through the whole exercise of a fingerstick.  A quick peek and we have a sense of what to do.  We’ve either eliminated the wonder or saved the inconvenience of an extra BG check.

And here is my favorite thing about CGM: I love, love, love the directional arrows.

Directional arrows make all the difference in the world to me.  If a regular blood sugar meter could tell the direction of blood sugar levels, even with just 10 points in time each day, that would be a huge improvement.  If Caleb is at school and the nurse calls me with an unusual situation, she will tell me his BG from the finger stick and the direction of the CGM.  This can change the course of action from that if only the BG was available.  If I had known the direction of Caleb’s BG that night after eating pasta at the restaurant, I KNOW we would have avoided that low.  I would have seen “121” and double arrows down.  That is so much more meaningful than just “121”.

The last enhancement worthy of mention is nighttime.  It’s  a little less grueling.  Looking at the CGM is significantly easier in the middle of the night than inserting a test strip into the PDM, poking a hole in Caleb’s toe and (often pop-eyed) trying to align that little half circle with the drop of blood.  Some nights I am so out of it, with little depth perception, that I am dabbing a blood-free part of his toe waiting for it to register.  I still have to do all that when there are out of range BGs, but the “just make sure” checks are much more seamless.

So here we are.  We were reluctant to start.  Underwhelmed when we began.  We are starting to adapt.

She just wanted some milk.

Lila
Lila

Lila is four.  Caleb was just shy of his fourth birthday when he was diagnosed.  In both appearance and personality, Lila tends to be more like Caleb than older brother Colin.  For some reason that has always made me think that if either Lila or Colin were to develop D, it would more likely be Lila.  Not logical, but it’s what I have always thought.

Driving home from preschool the other day, out of the blue Lila says, “Mom, can I have some milk?”  Lila has always enjoyed milk, but with her meals.  She has never been one to drink much beyond that, and if she does, it’s water.  For about a month before the light bulb went on that something might be up with Caleb, he requested milk.  It should have been a reg flag, but I was clueless. “Icy, icy cold milk,” he wanted.  Visions of him asking for it are etched in my memory because at the time, I just thought he was growing.  But it was a telltale sign of diabetes that I completely missed.

So when Lila repeated Caleb’s request, a pit formed in my stomach.  I started to think about the other symptoms.  Frequent urination – nope, not at all.  Lethargy – no way.  Weight loss – I really don’t think so.

But I couldn’t get beyond the taboo milk request.

We arrived home, unpacked her backpack as usual, and sat down at the kitchen table.  We’ve done it before, so it’s not a big deal – I ask Lila if I can check her sugar. “Sure Mom.”  I prick her finger, the test strip soaks up the blood and the five seconds of wait, which seem like an eternity, begin.  I’m telling myself this is not a big deal. She’s just thirsty.  She has no other signs.

Then the number pops up. 257. IMG_1783

Well that was not what I was expecting.  “Lila, let’s wash your hands.” “Okay mom.”

Another prick, another blood soak – error.  Another prick, another blood soak – error.  I’m trying not to panic.  But I am now thinking of the logistics of calling my husband to come home.  Do we go straight to the hospital or call Caleb’s endo?  Who’s going to get the boys from the bus stop?  Can we get her pumping right now?  Will insurance drop us with two diabetics?  And most of all, the flood of memories of Caleb’s diagnosis comes back to me in a wave.  Lila is starting to get anxious with the pokes and now they hurt.  How am I going to to get her through what lies ahead – shots, insertions, more finger sticks.  I’m looking at her in the eyes, trying to stay calm, but my heart is breaking.

Another poke, another soak. 168.  Not what I was hoping for.

I finally give her the milk she requested and the cookies from lunch she didn’t finish at school.  We go about our normal routine although I have little ability to process thought.  We are communicating, but I have no clue what I am saying because I’m still thinking about the hours and days and weeks and years ahead.  I give it about fifteen minutes, pull out a completely different meter, and we do another poke and another soak.

104.

That’s more like it.

Just like that, life resumes to normal.  My shoulders drop a little from the relief.  I give Lila a big hug and she is oblivious to the future I envisioned for her over the last twenty minutes.

Just to be sure, I checked her sugar later that day, 84 and the following morning, 82.

All she wanted was a glass of milk.

We walked.

Caleb at the JDRF walk - 10/18/09
Caleb at the JDRF walk - 10/18/09

We walked to raise diabetes awareness and funds for a cure.  We were overwhelmed by the generous response from our friends and family.  We set out with a total goal of $1,000, hoping for perhaps $500 of contributions that we would match.  You met that challenge and more than doubled it.  Thank you so much for all your support!

I’ve seen so many pictures of walk teams with blue skies, colorful t-shirts and well, sun and warmth.  Our pictures are a little different.  But that’s okay.  We walked in honor of Caleb and all PWD because we want better for them.

I’m so proud of my family.  It was pouring on us, forty degrees, strong winds whipping our faces and our path was riddled with puddles.  Lila was “bubble girl”, essentially wrapped in plastic.  Not a single complaint from anyone.  Caleb, Colin and David were the last walkers there – still trudging through the mud and puddles while others were packing their vehicles or were long gone.

At the walkThen we returned to our vehicle, took off our soaking layers and headed home, stopping for a well deserved treat of Dunkin’ Donuts on the way (I’m happy to report BG has been hovering between 80 and 100, with a nice flat arrow).

I knew we would create a memory today.  I had pictured it differently, but it’s a great memory nonetheless!

Anyone interested in making a donation to the JDRF can do so here. Or just click to see and hear the goal thermometer explode!!

IMG_3625_2

Taking the CGM Plunge

DexcomI admit it – I resisted.  Mostly because I could not bear to think of having to pierce Caleb’s skin for yet another reason.  Finger sticks and pump insertions seemed like quite enough. Adding a CGM – another poke, another pain, another apparatus strapped to him – seemed too much to ask.

But it remained in the back of my mind always.  Every time we waited for the blood drop to register – that little game of roulette we play ten to twelve times a day – what number would pop up? It’s part gamble.

Caleb and I talked about it.  He bravely agreed to try it.  I nonchalantly started the insurance process expecting it to be a long series of rejections and appeals. I was still reluctant and took every step with much more time than was necessary.

Then we went out to eat for grandma’s birthday.  Caleb chose his favorite – pasta.  I will not allow diabetes to make more choices for him than necessary.  So even though I hadn’t dosed him for regular pasta in a long, long time, I gave it a try.  I weighed his portion and bolused him reducing it by an amount I remembered working back when we weren’t eating new pastas.

We were off to a good start.  Blood sugars were behaving nicely.  But then shortly after he went to bed he yelled saying he felt low.  He was 22 and he got there within minutes. We’ve never seen 22 before.  More alarming was his reaction: “Mom, why does everything look so small?”  “Mom, I feel like I’m gonna die.”

He was back in range quickly.  But I don’t want him to ever experience that again.  I couldn’t help but think CGM would help.  So I stepped up the insurance process and within a week I got the call that he was approved.

Fast forward to the first insertion:

So how is it working?

As expected.

I made the mistake of expecting miracles when Caleb started pumping.  I didn’t make that mistake with CGM.

It is helpful.  It is informative.  I appreciate having to play roulette less.  I felt a sense of relief immediately being able to watch Caleb’s blood sugar change rather than get slapped in the face every two hours or so.

But, like pumping, it’s far from perfect.  Glucose readings must be verified before acting, so we have yet to reduce finger sticks.  In fact, we’ve done more than ever to verify all the ups and downs within those ten to twelve times a day we traditionally check.  It’s not always accurate.  Sometimes it’s WAY off.  But much of the time it is meaningful.  And it’s true what everyone says: the trends are the real value, not necessarily the numbers.  But, when it does work and work well, it’s actually pretty fabulous.

I really want the theory behind CGM to be the true reality of CGM.  I want it to tell me what his sugar levels are 24 hours a day.  It doesn’t.  It doesn’t “catch” his lows and highs. It alerts us to the possibility or even likelihood of lows and highs – but sometimes not even that accurately because there is a lag between its readings and his actual blood sugar. Compound that issue with its readings being off maybe ten to twenty points and it’s easy to miss lows.  So it can catch his highs and lows, but it doesn’t do that as a rule.

So far CGM has softened the extremes in Caleb’s blood sugar readings.  It is a step forward in Caleb’s care regimen. I am glad to have it.  It is, however, a much smaller step than I would have liked.

In all fairness though, we are still new to it, and I am optimistic that our learning curve will improve and the small step will become at least a little bit bigger.

Nevertheless, it is too much to ask.

Jump Start the Pump Start

One of those times the magic works!
One of those times the magic works!

We heard how great pumping would be.  There would be so much flexibility.  He would get his childhood back.  It would be much easier.  We would be able to tailor his basal for every hour.  Dosing could be as little as .05 units – so very specific.  Life would be grand!

Caleb was diagnosed in January 2007.  With everything everyone was saying, I couldn’t get him pumping fast enough.  I learned what we needed to do and did it.  We were carb counting from the day he was diagnosed – check.  I became proficient in adjusting his doses on injections – check.  We obtained insurance coverage – check.  I read Pumping Insulin from cover to cover – check.  I read the manual, got the training – check.

Caleb’s injection therapy had him eating 3 meals and 3 snacks a day of precisely the same amount of carbs at exactly the same time every day.  It was not easy.  Giving him 3/4 of a bagel for breakfast – that was depressing.  A low carb dinner allowed for a higher carb dessert, otherwise sugar free jello.  And oh how I disliked those pre-bed snacks.  I was just not a fan of eating right before going to bed.  I didn’t like finding carbs to eat – it messed up our routine.

I was ready for the miracle that everyone was describing.  We were now entering the land of eat what you want when you want. No more schedules, no more smoke and mirrors to make 50 carbs at each and every meal seem like exactly what he wanted.  Life was going to almost be like it was.  That’s what everyone was telling us.

Well, not exactly.

The rude awakening came the very first night of pumping, April 24, 2007.  Caleb’s BGs were good all day.  I was nervous because he hadn’t had his NPH that morning, but he was cruising.

Me and three kids in the house – hubby away on business.  I slept little, if at all.  We put Caleb’s first Pod on his tush.  I reminded him all day to be careful when he went to the bathroom – pull his pants over the Pod carefully.  Then that night, I myself forgot.  He woke up having to go and I helped him and ripped that Pod right off pulling his pants up or down – I don’t remember.  I just remember I had to do my first Pod change in the middle of the night.  That was not fun.

Worse than that however, were the 300s all night that would not correct.  300s???  Other than the trip to Universal Studios and the first couple of weeks post-diagnosis, we had not seen a 300.  Egad!  Correct, correct, correct.  All night.  He came down finally by morning, but I was a wreck. What happened to the miracle of pumping? The precise tailored dosing?

We did see immediately that there indeed was flexibility in what he ate.  There was no longer the 50 carb limit.  We cheered and skipped through the “beep-beep” of bolusing him for whatever amount of carbs he was eating.  We also saw right away that he did not have to eat his meals squarely on the hour.  If he was playing outside, we didn’t have to rush in for dinner.  And, yahoo! – the snacks were no longer necessary.  Would you like a snack?  Sure, no problem – “beep beep”.  But it wasn’t required.  No more panic at school for him to eat at precisely 10AM even if he was in Music. Woo hoo!  No more waiting for highs to come down with the NPH.  If he had a high (with the exception of our late night fun) we did another “beep beep” and he corrected nicely.

But I thought this little pumping machine that could deliver insulin in .05 increments – so much more specific than the .25 units we were eyeballing with syringes – would result in near perfect BGs all the time.  Wasn’t that what everyone was saying?!?!?!?!

No.  It’s what I heard, but it’s not what they were saying.

They said there would be flexibility – check.

They said he would get his childhood back – well, for the most part, check.

They said it would be much easier – check.

They said we could refine his dosing – check.

Everything we were told was true. However, with no experience and thus no perspective, those statements are subject to interpretation.  I of course now have that perspective and find myself saying all the same things, however, I know there is more to it.  I know that pumping takes commitment.  I know that you can achieve tighter control, but with tighter control comes more risks of lows, so diligence is required.  I know that pumping is indeed a wonderful improvement to Caleb’s life, but it is not perfect.

I find this dichotomy hard to handle sometimes.  I want to celebrate the advances we have today that make things so much easier, but it gives outsiders the impression that this is no big deal.  There was a report on NBC Nightly News with Brian Williams last night which gave me the same feeling.  It spoke about how much easier and manageable diabetes is today.  It is.  But it’s still very difficult and draining and stressful and restrictive at times.  Yes, it’s better and advancements have been wonderful.  But don’t forget about us world.  We still need improvements because it is far from perfect.

You decide

Caleb with his first Pod.
Caleb with his first Pod.

Deciding to pump was not hard.  Even deciding which pump was not hard.  What came after was a surprising challenge.

Six weeks after diagnosis, Caleb had his first endo appointment.  We covered many bases at this meeting, including insulin pumps.

I labor over the smallest decisions.  There is little that I take lightly.  I research, ponder, marinate, research a little more, think, inquire and finally decide.  When I decide, I am confident and committed.  By that point, I know what I want.

Pumping for Caleb was no different.

The nurse pulled out pump options and explained their advantages:

Animas: it allows for the smallest basal rate which is particularly important for children

Cozmore: it, in her opinion, had the best software

MiniMed: it has an integrated CGM

I sat with Caleb and my husband.  I listened to her describe the devices.  I waited for her to finish and asked, “what about the OmniPod“.

The nurse responded, “Caleb can’t use that.  He’s much too small.  It’s too big for his body.”

Perhaps what was said was not quite as surprising as the way it was said.  She implied that we were fools to consider it and further, we really had no clue what we were talking about. We were asked, “where did you hear about it”, as if it was important to know the source of our supposed misinformation.  We were “pooh-poohed”.

If you know me, you know that I am not afraid to speak my mind.  I am not afraid to go against the grain.  I am stubborn and outspoken.

If you know me, your eyebrows likely raised when you read the nurse’s response and you may have chuckled thinking something along the lines of, “this nurse has no idea who she is dealing with.”

A civil discussion ensued.  I explained that it was not too big.  That I knew of a child who was two when he began using it with success (Caleb was then four).  I had spoken to that child’s mother.  I explained that although I agreed the portion adhered to the body is bigger, the overall device that was effectively attached to the body was smaller.  She really tried to talk us out of it.  But her basis was invalid based upon what we knew.  We did not come to our conclusion without careful thought.  We could be wrong, but we wanted to at least give this a try.

With a smirk, she conceded.  I envisioned, “you’ll see”, going through her mind.

Shortly thereafter, Caleb began pumping with the OmniPod.  We dealt with various people at the endo office as he got started.  Everyone’s reaction included surprise that someone of Caleb’s age would use the OmniPod.  Nevertheless, they supported it.

Caleb has been pumping with the OmniPod for over two years.  We have never had any issues with the size of the Pod.  At the time, there was no one else at his endo’s office under the age of twelve using it.  For several of Caleb’s endo visits after he started pumping, the tables were turned.  We were being asked more questions than we were asking.  They could see that the OmniPod was a viable option for children Caleb’s age, and they wanted to learn from our experiences so they could advise other patients.

I believe Caleb’s endo felt they were providing reasonable guidance.  Because the OmniPod was relatively new at the time, there was not a lot to draw upon and I believe they simply made some assumptions about its use.  I am appreciative that they were willing to support our choice, even when they did not agree with it.

This experience solidified my understanding that I am my son’s greatest advocate.  Even including doctors and nurses with the best intentions, only I truly have his best interests in mind.

I will continue to research, which includes consultation with Caleb’s doctors.  However, I will continue to make decisions that I, and soon, that both Caleb and I have concluded are the best for him, either because of or despite his doctor’s advice.

To pump or not to pump

First day with the OmniPod - April 24, 2007
First day with the OmniPod - April 24, 2007

From the very beginning, when Caleb was in the hospital at diagnosis, there was talk of pumping. “Oh it will be so much easier when he’s pumping.” “Oh he’ll be able to be more of a kid when he’s pumping.” “Pumping will provide so much more freedom.”

Well why on earth are we giving him shots?

The thought of pumping at first to me was a little horrifying. I didn’t understand how it worked and my imagination formed images that I didn’t like. I envisioned a permanent “something” surgically implanted in him. It seemed very sad. Very medical. Very dependent. No one showed us what it entailed. We just heard how great it was.

I’m not sure when exactly I got over those self-formed images (which of course were all wrong), but I knew Caleb would start pumping ASAP. All I needed to hear was that it was the best way to get control, would result in the best BGs and therefore give him the brightest outlook. The rest didn’t matter. My early reading included the results of the DCCT study. Enough said. Sign us up. When do we start?

Even so, I still had reservations. In those early days I watched Caleb running around, being a three-year-old and tried to envision this device strapped to him. It seemed like the increased freedom came at the price of the loss of other freedoms. We were just picking the lesser of two evils. Sigh.

Bless our dear friends, Dan and Meri. Dan’s company was investing in this new product by Insulet Corporation – had we heard of the OmniPod? Why no. Could this be? Is there actually an insulin pump that you don’t have to be strapped to? This must be a mistake – something new and not yet approved. Why has no one else mentioned this to us????

I cannot express how fortunate we were at the timing of things. Dan’s query came at exactly the point when I was looking at the various pump options. Had he mentioned it a week later, we may have made another choice.

I did my research and I was sold. We were decided. We were going to give the OmniPod a try. Now how do we get it? And WHEN??

I was told, “Oh the insurance won’t just pay for it. Needles are cheap. Pumps are not. You will have to wait at least six months and show that you can’t control his BG on injections.” That was not appealing. I wanted to do whatever I could to keep his BGs in control. I almost felt like we were better off not keeping his BGs in range.

And that doesn’t even touch upon the fact that many insurance companies were not yet hip to the OmniPod in early 2007. Our insurance listed it as a CGMS and thus would not cover it. I was prepared for a battle. I had my ducks all lined up.

That was all misinformation however. As soon as we could, within 3 months of Caleb’s diagnosis, we submitted to our insurance our request for a pump. We were told it would likely be rejected and we would have to appeal. We didn’t. I got the call one day. “Caleb is 100% covered.” I’m sorry, can you repeat that? “This is Insulet Corporation and I’m calling to tell you that Caleb has been approved for the OmniPod, 100%.”

I was elated. It was the best news I had heard in months.

To pump or not to pump. It is a very personal decision and requires careful thought. It is not for everyone. But for Caleb we chose to pump. We are very glad that we did.