Tallygear for #DexCom #G4

Caleb’s been G4ing it since November. G4 Rocks. Period. Life will be even more exciting when DexCom Share is available. Like, soon, please, pretty please with sugar on top??

When Caleb used DexCom Seven Plus, he used a SPIbelt to carry the receiver. This served us well. Seven Plus needed to be on him to stay in range. He was young (started Dexcomming in first grade) so this was similar to taping it to his body to make sure it didn’t get lost. It was not overly intrusive on his expression of fashion at that age.

Caleb was a fourth grader when he started G4ing. The SPIbelt was becoming less appealing from a style perspective and Caleb was much more responsible with his diabetes devices. Also zipping and unzipping the belt to see the screen – less than ideal. And have I mentioned the range on this baby? The G4 receiver is often with me and sorry – but I wasn’t too keen on wearing the SPIbelt on a regular basis.

Enter Tallygear.

TallyGear G4

We started with Caleb’s favorite color, green, added blue for Blue Fridays, and got a couple others for fun – lightning blue and what we call lollipop – vibrant spirals. These are great – they provide an easy way for David and I to carry the receiver – we can use the strap, or the carabiner on a belt loop or attached to the strap of my bag. Caleb uses the carabiner to hang it from his baseball or dance bags. He otherwise will carry it in his pocket. Being able to see the screen through the clear case is molto bene.

Tallygear G4 FreedomYou see above David wearing it while coaching Caleb – Caleb can worry about stealing home while David plays coach and G4 moderator. What is notable in the middle picture is that there is NO receiver on Caleb (see the before photo) but G4 is still in use.

Tallygear Belt Clip

Donna from Tallygear also created a belt clip case. This clip is SOLID and it twists so the case can go horizontally or vertically. This is not Caleb’s preferred way to wear it – I see this as a great option for a more professional look for a more mature user. I like how it makes a nifty little stand to set at your desk. I can’t overemphasize the clip – it is really strong and secure; like I said: SOLID.

Donna has many other products including a new tote that includes a spot for G4 (or a phone) with the clear screen for visibility, and added space to carry other incidentals. If you have a need for a device case, I hope you will check it out. Donna has a great selection of patterns, her speed of delivery is second to none, and she is super accommodating. (Hey, I just noticed this bike case, which looks pretty nifty as well!)

If you have a Tallygear story or post, you are welcome to link it up in the comments. 

 

I Spy | Caleb Pitching

There are several difference between the photo of Caleb from Fall Ball (blue) and Spring Ball (green). One stood out to me more than the others. What stands out to you? (mine has nothing to do with baseball)

Pitching Fall 2012Pitching Spring 2013Yes, it’s the missing SpiBelt, and thus missing DexCom receiver. It’s around Coach Dave’s (dad’s) neck. Yet another example of the amazing range of DexCom G4!!!

A day in the life…with diabetes.

Just another day with diabetes.

Thanks to my fellow North-Easterner, Karen, for coming up with the idea of Diabetes Blog Week. I’m excited to be undertaking this week of blog posts with so many who have become my friends over the past year or so.  I’m guessing my RSS reader will explode.  Assuming yours will too, I’m keeping my posts short and sweet.

There’s something extra special about this week’s posts – they will be Caleb’s. This is Caleb… will actually be coming straight from the horse’s mouth.

So here we go.

Day 1 – A day in the life…with diabetes.

How would you describe your days in terms of diabetes?
It’s kindof whacko when you think about it, but I feel normal about it.  When I wake up, I just feel like it’s any other day.  It doesn’t bother me to check my sugar or do the other things I have to do.

It can sometimes make me busy. I check my blood sugar all the time and I sometimes have to take a break from what I’m doing.  Sometimes I feel low and I feel crummy.

How much of your day do you spend thinking about diabetes?
Not much.

What about school?
It’s really busy at school because I have to do a lot of school work and I have keep a routine about my diabetes, like checking with the nurse at 9:30, at lunch-time and before I go home, plus anytime I feel low.

Pod changes?
Changing my Pod can be stressful because it hurts sometimes, but I’m pretty used to it so lots of times it doesn’t hurt too much at all.

Eating?
Why do I have to talk about eating?  Everyone eats.  I have to bolus myself for whatever carbs I eat and Mom writes them down in a journal for school, but I can still eat whatever I want.

I chose the above picture for this post because of the story it tells.  I took it to commemorate Caleb’s first day of baseball.  Upon closer examination, I noticed several reminders of diabetes.  The tiger striped medical ID bracelet, the SPIbelt that holds his DexCom receiver, the open cabinet with his diabetes supplies peeking out, and even the stack of newspapers with the recent article of Caleb and his diabetes.  Just another day.

Day 2’s topic will be: “Making the low go”. See you tomorrow!

Super Bolus

Super Bolus by John Walsh
Super Bolus by John Walsh

First things first: this approach works for Caleb. It may or may not work for you. I am by no means suggesting that anyone should apply the following theories to their diabetes care. I am only explaining what I do for Caleb.

For weeks, Caleb’s most predictable BG of the day was pre-lunch. Without exception it had been in range. It was sensor change day and we were operating in the blind start-up period. No worries though because this time of day hadn’t posed an issue in quite a while.

It’s approaching lunch time so let’s do a finger stick. 289.

289?

Okay. Oh well. It happens. There was more fiber in his breakfast than usual and he was a little low at the postprandial check. Ah yes, hindsight is 20/20. Moving on.  Now back to this 298 and we are getting hungry for lunch.

Super bolus.

John Walsh explains it as follows: “A Super Bolus is created when some of the basal insulin delivery is stopped or partially reduced, and delivered instead as additional bolus insulin on top of a normal carb or correction bolus.”

The intent is to get glucose levels back in range quickly without inducing hypoglycemia. Here is how Caleb’s super bolus went that day:

Correction: 1.50 units, plus

Meal bolus for 50 carbs: 2.00 units, plus

Basal for the next two hours: 0.70 units, equals

Total units delivered: 4.20 units.

Lastly (this is critical) turn basal to “off” for two hours.

The change in the timing of the basal insulin makes all the difference.  Front-loading it and delivering it with the meal and correction bolus makes it act faster and all at once, thus bringing glucose levels back in range sooner.  If left as basal, the end result will be the same, but it will take more time and hyperglycemia will last longer.  The same amount of insulin is delivered when using a super bolus, it is only the timing that is different.

Back to life, start preparing lunch.

1/2 hour after superbolus: 169

Perfect. Coming down fast and lunch is ready, let’s eat. 50 carbs consumed.

1 hour after superbolus (1/2 hour after eating 50 carbs): 109

Excellent. The first time I tried this, I panicked a little at this point.  A 109 an hour after a bolus that large is cause for worry.  But his basal had been zero for an hour and he still has food in his system.  Plus his basal will be zero for another hour.

DexCom had been calibrated with that lovely 289, which we confirmed after washing hands with a 288. DexCom showed him cruising between 85 and 100 over the next hour.

2 hours after super bolus: 89.  Wonderful.

I know a bolus of that size is still hanging around in Caleb’s system beyond the 2 hour insulin duration that we use. However Caleb’s basal insulin has just now resumed.  He hasn’t received any basal or other delivery of insulin for the last two hours.  Any tail of insulin duration from that super bolus is required for his basal needs.

And it worked.  He continued to hover with a nice flat arrow through the afternoon until dinnertime when a finger stick confirmed a BG of 98.

I invite you to read more of what John Walsh has to say about using a super bolus. He suggests its use for high glycemic foods or large intakes of food in order to avoid blood glucose spikes. I haven’t tried in those situations yet, but I plan to. He also speaks of pumps giving us the option to deliver a super bolus automatically. The thought of it gives me chills.

In what ways have you used the super bolus?

Caleb’s 1st Complete Pod Change – Part One

No bubbles

Caleb has often helped change his Pod, but he has never done a complete change from beginning to end. There’s a level of dexterity necessarily to fill the syringe that fills the Pod. Considering the size of the needle used to do this, I have always interceded at this step. (I once stabbed the tip of my finger with that needle – it left an entry and exit wound and a half inch bruise from one point to the other. That thing is serious.)

But Caleb is seven now, and is showing more independence and responsibility in many aspects of life. Why not diabetes too?

When asked if he wanted to do the whole change, his face lit up, “really?”

With some expired supplies, our extra PDM, and his good friend Rufus, Caleb practiced. He did beautifully. I’ve always thought the hardest part of a Pod change is getting the bubbles out of the syringe. He listened to my instruction and did it with relative ease. Much better than my first time, that’s for sure.

Since then, the favorite thing to do in the house is to care for Rufus with bolus’, injections, bg checks and lots of love.

Here’s the video I put together of this monumental occasion.  Stay tuned for Part Two.

Our Happy DexCom Friends – video trifecta

As we began our CGM adventure with much trepidation, we were embraced, truly embraced, by our friends Bill and Suzanne.

I think the first time I “met” Bill was when he commented on Caleb’s low video and dubbed him a “Diabetic Ninja“.  Shortly thereafter he named Caleb “Diabetic of the Day”  in one of his own videos. Bill was one of the first people who found us through Caleb’s face on YouTube.  I remember how Caleb smiled when he saw that he was in Bill’s video.  As I’m sure was intended, it made him happy.

We have kept in touch with Bill and he and Caleb even have a friendly rivalry over their favorite baseball teams – Bill’s Red Sox v. Caleb’s Yankees.

Through Bill, we met Suzanne.  Suzanne and I tweeted a great deal about DexCom. She answered my unending questions and understood my apprehensions about putting Caleb through another skin piercing process.  She knew of Caleb and Bill’s relationship and asked if a video from Bill might help us prepare for our training.  Of course the answer was, “yes”.

So Bill and Caleb made a deal to make videos for each other.  Here’s Bill’s:

Suzanne also joined in the video encouragement:

To which Caleb responded:

Bill and Suzanne helped us so much through our CGM transition.  They went out of their way to make these videos for Caleb and sent us many heartfelt emails and tweets.  Thank you my happy diabetic friends!

“It’s all about your attitude!” Yours are fantastic, influential and even contagious!!

“The Day of the Hard Look”

Click to enlarge and read.

There was some news this week in the diabetes community and there have been mixed reactions.  Some are excited, hopeful and encouraged.  Others are frustrated, disheartened and even resentful.

I am a little of both.  I am cautiously optimistic.  That’s how I am in general, and I am the same as it relates developments in diabetes research and potential advances.

A friend blogged about her sadness regarding the outlook for a cure for diabetes after hearing the reactions from others to this week’s news.  The fact that a time frame of five to ten years for a cure has been given to people diagnosed with diabetes for tens of years was a little more than discouraging.  I understand and relate to this.

This is my reply to Rachel:

I don’t think people are made much more skeptical than I am.  I have this book which dedicates a page to every day of the year and describes what people are like based upon the day of the year they were born.  My day is called “The day of the hard look”.  It defines me perfectly – anyone who knows me is fascinated at the eeriness of the accuracy of this book as it relates to me.

That being said, I have hope.

I don’t really understand why people (doctors) need to define a time frame to this. I suppose it’s because it’s something we all want to hear. Giving it definition when it is IMPOSSIBLE to define is what makes this situation that we are in. Once the measurement is defined, we have something to look at and say, “well that didn’t work – they were wrong – they lied – it WON’T happen.”

But I haven’t given up. The time frame may be wrong, but the theory, I believe, is right.

There ARE resources – many resources – tasked to tackle this. I don’t have the slightest clue when their efforts will be realized, but I truly believe they will be. It may be 100 years from now, it may be 10. But I believe this puzzle will be solved.

None of us are sitting around waiting for a cure. We are all doing everything we can to keep ourselves or our kids healthy now.

I think of the people who lived with diabetes in the early 1900s who starved themselves to live another day, every day, in hope of a cure. The cure came for many of them.  It was insulin.  It saved their lives.

Now I am NOT saying that insulin is a cure, because I know darn well that it is not. But for these people it might as well have been. From their perspective it was.

I hate what diabetes does and makes us all do as much as anyone. But, I am so very, very thankful (ok, I’m choking up now) that Caleb has the benefit of the advancements that exist today. Even on the worst of days, when I don’t think I can take another second of the crap that diabetes presents us, I remind myself it could be so much worse.

I don’t know when there will be a cure, but I am still hopeful.

More than that, I am hopeful that along the way there will be many more advancements that will make living with diabetes easier and safer. If there are as many in the next 10 years as there were in the last 10 years, living with diabetes in 2020, when Caleb is just 17, will be a very different thing than it is today.

I have read a lot of the responses to Wednesday’s news and appreciate the varying perspectives that have been shared.  Although different, and at times at opposite ends of the spectrum, I am able to relate to most of them.

I am “the day of the hard look”.  No one who knows me would argue this.  But I am still optimistic.  Cautiously optimistic, but optimistic nevertheless.

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.