DBGB's

Medtronic Nightmare

2007-06-27T16:11:00.000-07:00

The situation: I've been using a Medtronic Minimed Paradigm insulin pump for about five years. This past September, I finally upgraded to their 522 model, with Bolus Wizard programming, and was promised that I would receive a $500 rebate on my old pump when I returned it. I was sent a USPS envelope in which to return the pump (strange, because when my old model malfunctioned they always sent a UPS package). I returned it, and now, nine months later, they tell me they haven't received it.

I've been receiving these calls for months now, and I repeatedly tell them: I RETURNED THE PUMP. THERE IS NO TRACKING INFORMATION. IT IS NOT MY FAULT.

Meanwhile, I have a balance of $1,000 that I can't pay on my bill.

This hasn't been a huge problem. Until this week.

This week, I called to enquire about their Silhouette insertion sets, which are manually inserted diagonally. I need these ASAP, because I've been having all kinds of obstruction issues using new sites: sides, buttocks, legs. The problem is I have very little fat on my body, so there's not enough cushioning for the set (recommended one inch of fat for a good site). I get obstruction after obstruction after obstruction. I've checked my basal and bolus rates with a good infusion, and they're fine during the day and overnight. On the rare occasion I get a clean, 48-hour set, my BGs are usually fine.

Anyway, having asked about the switch, I was told that my account had been blocked. This means that they have decided NOT TO SEND ME ANY SUPPLIES until I pay my outstanding balance. Yes, you heard me correctly: THERE IS A WAY TO BE DENIED INSULIN SUPPLIES DUE TO BILLING ISSUES.

How bad is the situation? I was on the phone with Medtronic, on and off of hold, for what must have been an hour and sporadically throughout the day on Monday trying to get it resolved. The associate I spoke to was totally clueless and claimed he would have to "do more research" with his supervisor. He said he would try to get a "temporary lift" on the ban and send me new supplies by today. I even agreed to exchange some of my old infusion sets for the Silhouettes.

Guess what was not in my mail today!

I'm absolutely fed up with Medtronic, and I'm strongly considering trying a different model pump, simply because their customer service is so bad. Me, a LIFELONG customer who has NO CHOICE but to continue using their product is now going to make a drastic change in his health routines...ALL BECAUSE OF BAD CUSTOMER SERVICE!

Needless to say, I am completely and totally infuriated with this company. I wrote a letter to their president, left messages with all associates I've spoken to (not even a response so far), and would now like anyone who has had similar experiences to please add my name to whatever petition might be going around to TAKE MEDTRONIC TO TASK for their inexcusable customer service!

Fiber Audits

2007-06-17T13:00:00.000-07:00

Let's try out a brand spankin' new metaphor here: FIBER AUDITS.

Premise: Think of your body -- in regard to how it responds to insulin "payments" -- as a big, scary IRS. You've got enough issues with its incompetence, being the bureaucratic behemoth that it is, not to screw things up in the first place without needing to screw things up yourself.

Even when they've written into their own code that certain carbs are deductible: FIBER.

Yes, this is in the code, but the code is tricky. You don't fully understand the code, and you're not an idiot -- you can even follow the storylines in pretentious Swedish existentialist films on occasion.

You have to learn early as a diabetic (if you want to keep your sanity) that nothing really goes for everyone. Diabetics are the trodden-upon mass taxpayers, non-diabetics are the ones who always seem to know how to cut corners and cheat and swindle and nip and tuck their way into the next highest tax bracket, where, ironically enough, they will pay even LESS in taxes.

Er, point being, ya can work to change the fact that you're a downtrodden diabetic at the behest of an incomprehensible system, but you also need to do the best you can to keep your head above water.

Enter FIBER AUDITS. I, being a downtrodden taxpaying diabetic, have been led to believe by doctors and nurses and websites and nutritionists that I can safely deduct fiber from my insulin taxes. 5g here if you opt for the blander cereal and -- my gosh, this MUST be a mistake -- a whopping TWENTY-ONE GRAMS (out of 30) for whole wheat tortillas!

I'm a guy who enjoys a nice, plain quesadilla. A simple-pleasures type. Flat bread and cheese. And to throw in this bonus of five or more times the amount of fiber I'd usually get (trade-off usually being a distinct cardboard flavoring) for a still-tasty treat! Finally, the downtrodden get a break!

Oh, if only it were that simple.

See, I understand the code. But fact is, every time I do a fiber deduction, I get AUDITED. Alarm bells go off and, when I try to sneak in that unthinkable twenty grams of fiber, I get SEVERELY audited. 320 BG in an hour, with a pre-meal BG of 109. No pump obstruction -- because the Insulin Revenue Service misfiled my return papers LAST NIGHT (i.e., standard-issue blood-spurtin' pump malfunction!) and I already cleared it up with them in the bathroom as it happened. I've too recently learned not to sit on these problems and to correct immediately, never to assume "they'll be open in the morning" -- and I'm not afraid of using some foul language to get my point across.

So I could sit here and gripe all I want that I'm a downtrodden diabetic getting screwed by the (delivery) system (which I am), or that it's not MY fault my body is a complicated series of utter catastrophes (which it isn't) or that by all rights I'm entitled to my fiber deduction and BY GOD I'll claim it! Because I can't. Because every time I do, I get audited, and getting a fiber audit is a pain in the ass.

So instead there's the (slightly less pain-in-the-ass) alternative: pay in full, even though I'm entitled to the deduction, and deal with the "refund" (=hypoglycemia) later. And heck, I can even think of it as a refund -- pay a little extra up front and enjoy a bag of almond M&Ms, or a Sesame Street juice box (now in Cookie Monster ORANGE -- what, was "cranberry" too much of a no-brainer??), or a handful of pretzels. It'll get me exactly what my real refund gets me -- a simple pleasure -- and won't affect my overall financial/insulinial situation one damn bit.

And that's when you take a deep breath and remember what the wise E.B. Cooper once wrote about PERSPECTIVE, via two inkblobs in her influential underground comic strip "Inkblobs #3":

Inkblob 1: "Having perspective" helps one realize the true consequences of one's potential actions in the entire scheme of one's life, decreasing agitation, anxiety, and a worrisome sense of personal unimportance.

Inkblob 2: My perspective sucks.

[EDIT: Of course, you can't rule out the possibility that you're getting audited AND there was a mistake with the paperwork. Not only did I not get enough insulin for what I was eating, I also didn't get any insulin (thought the high seemed REALLY high) because there was a second pump obstruction in 24 hrs. Grrrr. BG back down to 120 by bed.]

Blueberry Pancakes

2007-06-10T19:21:00.000-07:00

Sans the pancakes. Mit zero-carb whipped cream (handmade, no Splenda necessary since the blueberries cover the sweet). Probably a total of 10 carbs (or less) and quite delicious!

Glad to find a low-carb dessert type treat because my BG is about 350. Had a bad "dinner" (really a glorified, uh, linner? lupper?) over at Mixto, a nice Cuban/general S. American place nearby that seemed chain-y when we moved here but turns out to be a really nice place with excellent food (and great drinks, though I tend to avoid 'em), reasonably priced.

That stuff's tricky, esp. the way I do it, MIXED APPETIZER style. Lots of fried foods, fat, meat, and straight-up starch plus those unbelievable sweet fried plantaines all in all probably consumed between 60 and 100 carbs and covered for (at least) 70, though I staggered it because I feel uncomfortable giving myself a hundred-carb bolus all at once. Dual wave can work OK for specific meals (sandwiches, maybe steaks and some fish), but for hardcore eating, multiple blasts is the only thing that will cover the delayed carbs.

But this was probably too much anyway, even given the staggered INSULIN BLAST.

Still, I give myself three, plus one, plus one, plus (I think) one -unit attacks and it does nothing to curb my BG from getting way too close to 400 for comfort. I'm lucky that I'm not particularly sensitive to hyperglycemia, so ketoacidosis (diabetic coma) has never been an issue for me. I hear tell (from TV) Patti Labelle collapsed onstage with a 500 BG, but that'd just make me have to pee really bad.

I do an additional three units correction, suspecting I've also had a now-common but unexpected pump failure. And I was right, nearly an hour after correction #2 my BG hasn't budged. So another pump change (just changed it yesterday) and another 3-unit correction.

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What makes me uncomfortable with this BG-chasing is that about a month ago after a (relatively mild) bout of BG-chasing my blood sugar plunged down to 40 in the middle of the night (not very common for me, though it's not unheard of for me to go to 65 or so overnight). I ended up chasing the subsequent three or four lows that ensued with about a half a gallon of OJ until my BG shot up to 300 and I ultimately corrected with a syringe before going back to bed, got my BG back down to normal the next day after breakfast.

I've never had several consecutive lows like that before -- I was at the ready with my emergency glucagon (luckily this was the weekend so no work the next day). Before this year I probably wouldn't even be able to tell you where my glucagon WAS, let alone ever think of using it. Only thing worse than being on tech support at 4 PM...

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There's always cheese, I guess.

Sometimes ya gotta give it a shove

2007-06-07T12:36:00.001-07:00

Observation of the day/week/month:

When my basal rate fails overnight (as it's been doing every three days or so, despite the fact that I've been changing my pump every TWO days) and my BG spikes up in the morning, the first bolus NEVER takes care of the high.

Case in point: last night after our lovely anniversary dinner, I had my BG down to 200 even after restaurant flat bread and vanilla rice pudding (and a few bites of sublimely delicious chocolate cake) thanks to about 4 units of insulin (my insulin:carb ratio in the evening is 1:15).

By the evening -- 280. Fully corrected.

In the morning -- 260. Changed pump.

After that correction -- 270! With a new pump! So I corrected again and got it down to about 200 before I had lunch I could cover (with full coverage plus a little extra).

Now it's about 4:00 and my BG is about 190 (an hour and a half after eating), which seems about right. My on board insulin should cover the rest in another hour or two, which means there's no pump problem (yet). EDIT: 5:30 BG is 98! How am I always so right??

So here's what I think happens: When my basal rate fails for an extended period of time (usually over night), something about the prolonged lack of insulin (and it was lack of insulin -- when I changed my pump there was a "hard bump" and the telltale smell of blood 'n' hospital = TIME FOR A CHANGE) creates a kind of resistance to the new insulin. Even though my BG doesn't correlate with how much insulin I (presumably) missed, I still need as much insulin as a BG level that would indicate the extra shove in the downward direction (by my estimation, I'd need nearly a 400 BG to correct with that much insulin).

I can rule out meter error, despite my many other conflicts with my One Touch Ultra II -- but the OTU2 usually reads too high, almost never too low (unless I'm having an anxiety spell in the middle of the winter and check my BG outside; then it tells me exactly what I'm most dreading to hear -- YOU'RE ABOUT TO PASS OUT IN THE STREET! HAHAHAHA! Malicious lying little bastard!).

So my conclusion from experience: like me, my pseudo-pancreas needs a swift kick in the ass in the morning when it's feeling particularly groggy. I guess we have something in common after all, aside from the sleek design and glow-in-the-dark face (note: mine is only effective when I smile under a black light).

Heebie BGs

2007-06-06T18:41:00.000-07:00

High, through the roof, sky-rocketin' lately. Reasons, as far as I can tell:

1. I am skinny (cue world's smallest violin), so my pump infusion sites are pretty unpredictable depending on how much fat there is in a given site. The back-sides (also known as the RUMP) work OK for now, stomach around the navel has been unpredictable, legs don't work period (the tube bends up!), side-sides are about 50% effective.

2. Though I have avoided actively paying for them, I still eat danishes when they are free. (Note to self: AVOID THIS.)

3. I'm not bolusing with enough time before meals to catch the carbs -- insulin is kind of like a parachute, release it too late and BAM!

4. Superbolusing frightens me. (Note to people not in the know -- superbolusing is a method by which you "forward" yourself your basal rate for two hours along with your meal bolus, then cut the basal rate for two hours.) It reminds me of, like, bungee jumping or something. I mean, yeah, it works and you won't get hurt, but really, wouldn't you just rather avoid jumping off the bridge??? (Note: being melodramatic -- I should try this method sometimes!)

5. Exercise, exercise, exercise. These are three things currently missing from my life.

Ohhhhkay. So let's take #2 off the table (or, rather, minimize 2 and consider it a fluke, since obviously it will happen occasionally, though hopefully not again anytime soon -- EVEN MINI-DANISHES ARE DANISHES! Must remember this. BG went to 400 after two of those suckers, though I got it down to 130 after correction, so it wasn't a pump issue).

Regarding #1, I've already tried the diagonal self-inserted infusion sets once, and it worked fine, even in the leg, which usually doesn't work very well with my regular infusion set (I use Quickset). Should probably order more of these, although inserting them makes me feel like I'm in a low-budget horror film. (Maybe I just need to make the appropriate musical selections, like the Rosemary's Baby Theme or something?)

Re: #3...this one's a problem. I've managed to give myself enough time in the mornings, but dang it I just get TOO HUNGRY most of the time too close to when I eat. Then scarf down quickly, bask in the afterglow, and deal with the inevitable post-prandial spike. More restraint? More watch alarms? Pretend that my food is a reward for the great patience I've exhibited, like a dog balancing a treat on his nose? (Though my girlfriend would get a kick outta this method, I think it would be relatively ineffective.)

High-fiber tends to work -- full bolus for, e.g., heavy-duty bean meals tends to level at a 170 or lower peak, even if I eat soon after bolusing. But I can't eat beans EVERY day, just every other day.

Re: #4, maybe I'll try a SUPERBOLUS after my good time dessert type standby, almond M&Ms. A great subsitute for, uh, regular M&Ms (half the carbs due to much almond goodness, generally healthier). But usually when I would normally superbolus (almond M&Ms, though delicious, are only 20g carbs, which I can cover normally most of the time), I have no clue how many carbs I'm ingesting. Will work up the courage sometime or other.

Anyway, this is an initial vent post, will try to go semi-systematically into my various issues a little later, thought I'd just start winging it and see where I get.

Final vent of the day: one thing I've noticed from my (relatively scant) diabetes blog cruising is that there is still a lacking community for collegiate/post-collegiate diabetics. I'd love to know where these communities are online (since I assume I just haven't really found them yet), but the real problem I've had is in the real-life component of diabetes community: lots of support groups for children and parents of children and Type 2 adults, but few for the 17-30 crowd, when diabetes control is both extremely difficult and extremely crucial to continuing good health.

But perhaps I'll find more folks like me as I go along! I also thought I was the only guy writing about teenpop on the internet, and that I was the only guy who wanted to start an all-diabetic girl group, but I was wrong on both counts. Just goes to show ya that anything is possible...and, um, that there are a lot of weirdos (like me) out there!

Dave's Blood Glucose Blog

2007-06-04T10:37:00.000-07:00

Welcome to Dave's Blood Glucose Blog. Let's run down the stats, shall we?

NAME: Dave

AGE: 23 (as of Feb. 2007)

DIABETES: Type 1 (Juvenile/Mellitus)

SINCE: 1999

CONTROL METHOD: Paradigm insulin pump

LAST A1C: 8.4

AVG. BG: 170-180

So that should tell you all you need to know about me.

Oh, wait...

My name is Dave. I'm 23, I'm living in Philadelphia, I'm starting a film/video MFA graduate program in the fall, I spend most of my time thinking and writing about pop music, and I've been a Type 1 diabetic for about ten years.

I'm starting this blog because, as seems to be the case for most post-collegiate early twentysomethings, it's time for me to start getting my act together a little. (With diabetes, you need to accelerate this process considerably -- for the last eight years I've managed my diabetes about as well as an off-the-wagon alcoholic manages drinking.) I have a girlfriend of four years who has seen me through the rough patches and is helping me into the (relative) clear, and I have a few key friends who have been supportive.

But otherwise I'm something of a private guy, and I think and write a lot. I thought that it would be beneficial for me to take my issues with my condition to the same place I take issues with authorship in teenpop, aesthetics in experimental documentary, and funny things I overhear strangers saying to each other on the street: the interwebs.

My mind moves pretty quickly, which means that my writing can be copious and impenetrable. (And on that note, if you're interested in pop music, you might want to try keeping up with my other blog, The Cure for Bedbugs.) But I want this to be a place where I can articulate some of my day-to-day concerns with diabetes management and, with any luck, help foster yet another mini-community within the informative and unwaveringly supportive diabetes blogosphere.

As I get used to writing and navigating the diabetes blogs, I'll add 'em to the sidebar. For now, though, I've started with some basic links, and the one personal blog that has most resonated with my own struggles with diabetes -- Six Until Me, which I really can't recommend enough for wit, candor, and insight.

Hope to keep this pretty regularly updated -- diabetes never sleeps (I usually manage to, though: juice boxes by the nightstand just in case).