I am a 30 yr veteran of T1. I have had T1 since the age of 7, I guess you can figure out me age, ha! Last year I was diagnosed with hypo-unawareness. My b.g. will drop and the first symptoms I have is tunnel vision(right at the point of passing out) or I start to convulse. I am aware of what is going on around me but I am not able to put my thoughts into words and talk. My b.g. has gone from 147 to 41 in fifteen minutes and no symptoms of it dropping. I treat my lows with 15 carbs and recheck by b.g. after 10-15 minutes and repeat if needed. Then usually within 2-3 hours of a low I will rebound to anywhere from 300-500. Some days this happens more than once. I am using a medical alert service dog to alert me when my sugars are dropping. He is fairly young and not 100% on his alerts, but he has alerted me a number of times at home and in public. He usually lets me know when I am about 100. At first I thought he was goofy, but after a few times of him doing this and then me dropping in the 40-50 range within 15 minutes of his alert, I rely on his judgement and drink some juice even if I am at 100. I no longer drive or stay alone with out someone knowing my schedule and keeping a cell phone on me at all times. I am on an insulin pump and have been for the past 8 years. I think my b.g. would be much worse if I were on shots. I am wondering if anyone else suffers from this kind of complication and what you have done to cope or even regain sensitivity to low sugars? I am in contact with my doctor weekly. We are making adjustments to my pump and we've changed brands of insulin. I'm currently on apidra, with no significant improvemnt after 3 months. I exercise regularly. I walk and bike with my service dog usually 5 days a week, working in errands around town. I also do janitorial cleaning 1-2 days a week for 3-4 hours a day. I eat healthy balanced meals, and check my b.g. 8-12 times a day. I am trying to find the positive and keep active, but I am wearing out physically and mentally. Any ideas or help would be appreciated.
Re: Is anyone dealing w/ hypoglycemic unawareness?
Quote:
Originally Posted by blacklime
I am a 30 yr veteran of T1. ...... Last year I was diagnosed with hypo-unawareness. .......
blacklime,
Like you, I am also a long time T1 (29 years now). And the hypo unawareness seems to have got worse over time. At one stage I would drop to below 40 before feeling anything. There has been a small improvement and I now feel notsogood at about 50. But this is still too low for comfort.
The biggest help in avoiding the lows was to get rid of blood sugar volatility caused by a high-carb diet (about 200grams of carb a day). Cutting back to about 50 grams of carbs a day means that I don't need to inject so much insulin. So my blood sugar doesn't drop as quickly or as low, even if I get the quantity and timing of it wrong.
I had hoped that not going hypo so often would make the hypo unawareness go away. But that doesn't seem to have happened. My blood sugar still drops too low for comfort before I feel it. But, I am happy to say, it isn't anwhere nearly as much of a problem. My blood sugar now only drops very slowly, and I normally pick it up in a random test. I also test 8-12 times a day.
I also used to have severe problems with convulsions. It was terrible and, after overcoming the problem, I feel like I have got my life back. The secret IMHO is to remove the volatility in blood sugar levels. If you can do this, you won't be overwhelmed by a sudden crisis. And the key is to re-train your body to use fat as the main source of energy. You do this by removing carbs (sugar, bread, potatoes, rice, anything made with flour) from your meals and replacing them with fat/protein (meat, fish, chicken, dairy, nuts).
Cheers,
Mark
__________________
Type 1 since 1977. On Lantus, Novorapid and Actrapid.
Re: Is anyone dealing w/ hypoglycemic unawareness?
I have hypo unawareness. My endo recommended I use 160 as my target bg for a month or two and see if I can get some awareness back. He said not to let myself go below 90 during that two month period and to treat a bg of 100 as a low. And guess what, it worked! I have some awareness back, but still not a normal amount.
Re: Is anyone dealing w/ hypoglycemic unawareness?
Endos are now recommending that you run higher glucose levels consistantly for a couple of months to return your awareness. The recommendations vary, but about 180 is what I have heard most often. Many people with unawareness don't like to do this because they don't feel that great and are worried about complications. The problem is that your body has gotten used to a too low level and doesn't bother to warn you any more. You may not feel that great at first running high, but it will work. As for complications, you won't cause major complications with just a couple of months of higher BG. Complications occur with long term high glucose levels. Also, the immediate dangers of unawareness are quite obvious to you at this point.
I would have a chat with my endo and run my levels higher for a while and hopefully that will help.
Re: Is anyone dealing w/ hypoglycemic unawareness?
My daughter, a 37 year type 1 diagnosed at age 9. You can then probably guess my age! The 10 year span between her diagnosis and years produces big advances in diabetic care. If there were home blood test I was not aware of it. I don't have any blood glucose for that period but she dropped fast, and she still does. The scary things is that she has always referred to be alone. A few months ago she had to put down her best friend and constant companion. She is now considering a puppy that she thinks she can train. So much depends on their inherent abilities but the latest dog, while not trained to do so alerted her. She has a great love for dogs and can get a dog to do almost anything. I will feel better if she has a dog. She recently researched laws in regard to service animals and found that there are almost none.
How did you acquire your dog and any other information you would like to share.
Betty
Re: Is anyone dealing w/ hypoglycemic unawareness?
Cora and Mark1e,
Thanks for the info. My overall target is 120 on my pump. However, we are using the 180 mark as o.k. My b.g. have to get into the 300-400 range before I start feeling yucky. Since I rarely show keytones, I will often hit 500+ and not feel too bad. I will treat an 80 or below b.g. with a 6oz juice, but often rebound between 250-350 within 1-2 hours. When I treat with a snack bar or a glucerna bar, it takes too long to get into my system and I continue to drop dangerously low. So my doc decided to have me go back to juice and deal with the high rebounds. It is crazy!!
I am careful not to over treat, but even so there seems to be no middle ground--yet. My doc agrees to run my b.g. higher end, we are using duel wave on the pump to extend deliverance of insulin after meals and snacks so that I don't have an overload of insulin to start with and then digest my food later and not have insulin to cover. I give a correction and then waiting 2-3 hours to correct again if still high so I am not piggy backing the insulin. Some days I know my b.g. is fighting to raise, so then I do take insulin closer together, but test often so I know when it is on a decress.
I am using a 1-12 carb ratio for insulin:1 unit for every 12 carbs.
I am on a 1-50 correction: 1 unit to drop 50 points
My average daily insulin amount is 40 units. 21.45 units as basel and 15 to 20 units as bolus to cover foods. What is your average insulin dose?
For my height and weight (I am 15 pounds over weight) the basel insulin is where it should be and over all to maintain my weight, I am not taking too much insulin. However, with less carbs, obviously I'd use less insulin. The less carb idea sounds like something to try out. I keep in mind the glycemic index and try to remember if I eat a higher index food I may raise my level quicker and need extra insulin to cover. Also high fat foods take much longer to digest, so I extend my insulin delivery to 1 or 1 1/2 hours. My usual deliverance is, I take 70% of my dose at meals and the remaining 30% is drawn out for 1/2 hour. This worked for a while but I am needing to make some adjustments to this again as my b.g. is too high 2 hours after meals. It can be 120 at meals and then be 250 1-2 hours after. What is frusterating is, as you know, no two days are consistant. There are NO patterns to work from.
If you guys have any more ideas or suggestions, please send them on. I'll try to reduce my carb intake again and see if it does the same thing as last november. I ate exactly the same carbs for each meal and snack, recorded everything I ate, drank, exercise, activities. I Kept the same schedule for exercise daily. I did this for 3 months and 80% of my b.g. were under 70. This was based on a monitor program I use to down load graphs and data to keep track of my trends and problem areas. Most were in the 50-60 range.
I was eating: B. 45 carb
L. 45 carbs
snack 15 carbs
D. 60 carbs
snack 30 carbs
My current (last week) A1C was 8.5, so over all I am way high. It is these unexpected lows that are hard to keep from happening. Two days ago I ran 200 from wake-up 7:00a.m. until 3:30 p.m. I decided to go biking with the kids. At 1 1/2 miles down the road my service dog decided to lay down and not move. I knew he was not tired, since we usually go average 5 miles when we bike. I got out me kit and it ws 45. Had the dog not alerted me, I'd have gone till I passed out. I had no feelings of low until I stopped and sat there a few minutes then I began to tunnel. So even at a 200 level, it will crash fast and hard. Oh, I think I ate cheese, meat and 1 oz dried fruit before I left.
Thanks for any help. Sorry for the novel length reply!!
Re: Is anyone dealing w/ hypoglycemic unawareness?
Betty,
I have researched a lot in the internet, gone to diabetes seminars, and talked to anyone and everyone to find out of others who are using service dogs for diabetes alert. There are organizations that can train or help you train a dog. They can be expensive and take years to aquire a dog, but that is an option. I got my dog from a private breeded who began his training for simple basic obedience at three weeks. By the time I got him he knew sit, stay and come. He was very young, but had the basic idea of what was expected. At 8 weeks we were in puppy class for obedience training. We worked on the hypo alert seperate from that.
I spent hours taking him to parks, schools, up town on walks, and anywherre places would allow regular dogs in. This was all for socialization. It is VITAL that a service dog be familiar with all kinds of people and situations and be accepting of them. Kids, babies, older folks, handicapped, wheelchairs, bald, long haired, other races and nationalities ( without being disrespectful, people of different races often have a particular scent that may be different than our own), People in uniform (police, mail carriers, emt, ect.), people on bikes, scateboards, rollerblades. These are but a few, anything you can think of that your dog might be in contact with later in life, introduce him to between 12 and 16 weeks if possible!!!
For the hypo alert, I put together my own program. Because a dog can only learn to alert to a scent when that scent is present, you must train for t to recognize that when your b.g. levels are low. It's like training a drug dog to detect certain scents and alert when he smells those. We also play a retrieval game. He has learned to 'find my kit', 'bring it', and place it in my hand or on my lap. To do this I started by getting in his face when I was low and talking to him and using my certain words to cue him that I am low. Kind of like "When you smell this then you are to...". From there we worked on finding my kit at a certain spot. After he knew what the kit was, I began putting it different places for him to find. Then he had to bring it to me. We worked in the same place for weeks to get him used to the routine, and then began sitting or laying different places for him to bring it to me. I used an assistant to direct him at first so he knew where to go and find it and then bring it. ONLY I gave the commands, my assistant just directed him in the right dirsction. Always, always, always, praise and reward with a toy or treat. Something special that makes him want to 'find it' again to get the reward. It takes alot of time and patience and repetitions. And then it takes more of the same.
As far as the service dog laws, it does seem that there are not alot of laws. However, I would caution anyone, if you are serious and going to put a dog into service weather you train your own or have it trained through an organization, think it trough carefully. The dog is never done with training, it will be in training until it retires or dies. And the handler has to be the one doing it. The person needing the dog has to be the one feeding, walking, pottying, grooming, sleeping with, doing the care for the dog. He has to bond the the person needing him and focused on that person. If you start with a puppy, you will have the challenge of puppy training, the "teen-age" years of ignoring and testing the limits, socializing and public acceptance of your dog. You will need to research you states laws on 'dogs in training' and if the are allowed in public places or not, which can limit your access tremendously.
Then once you feel you can take your dog in public you'll need to decide if he is up to the bussel of stores being busy with a lot of commotion, smells, people grabbing at or trying to play with you dog, people being hateful and yelling at you for having a dog with you. How will your dog react to such things? Will he jump up on people, bark, growl, whine, cower, grab at tags on clothes or items on the shelf, squat and pee because he is stressed, or just can't wait for you to take him out, eat off the floor, shake inside a restaurant or business. What if a cart rolls over his tail, will he stay still or react with a defensive move? What if a child comes up and throws his arms around you dog before you can react? What if someone tosses him a bite of food to "be nice", will he ignore it? What if a child walks by with an ice cream cone, will he keep going or decide he needs a lick too?
There are thousands of other questions to ask, but hopefully it's clear. You may not feel there are laws concerning the use of service dogs in public , but there are unwritten laws that are followed by the majority of service dog users. We must all keep in mind that people depend on these dogs and often put there very lives in the paws of these animals so we would never want to put an animal in service that could harm or damage people or property. We must have control of our service animals and be 99% sure of how our service animals will react in as many situations as we can dream up. Nothing is 100% when dealing with another being who can act and react on their own. But any negative experience with a service animal in public makes it that much harder for the next person to be in public.
A good place to check out is the web site for Delta society and the public access test they use. Also Therapy dog traing and certification is an area you may want to research to see how much work is involved and what they require to certify a dog. These are great guidelines to follow and set as a goal for you and your dog to aim for.
Obviously, if your daughter is only going to use her dog at home or in the company of friends and family, much of this is n/a, but if she wants to use him in public there is a lot to consider. It takes a great deal of commitment.
I hope I have been of some help and if you have any more questions, please send them
Sincerely,
blacklime & puppy
Re: Is anyone dealing w/ hypoglycemic unawareness?
Thanks for the information. She is trying to think of all the details.
Have seen the "dog whisperer". My daughter handles dogs as well as he does. Recently she vacationed a week with friends. They had 2 dogs that was driving the neighbors crazy. When she left they were different dogs.
She has had 2 labs, from puppies to the end. The last one was very recently put down. She is a boat captain and the dogs were always with her. They took whatever comes with out problems. The last one was exceptionally brilliant and had a big vocabulary. Labs are very social dogs and different people were always on the boat.
At the present she is on sick leave and there is a good possibility that she will not be able to return to that job. She does not take any job that the dog can't be with her 100%. So the future is not clear at this point but she tentatively has a lab puppy that is now gestating. By the time that puppy is ready to leave its mother hopefully she will know what she will be doing.
Training a dog is a full time job and she has had her dogs with her all the time. Being a loaner she always interacts with the dog. She is gathering information and has the confidence to do it. Time will tell how it goes.
Re: Is anyone dealing w/ hypoglycemic unawareness?
Betty,
I'll be anxious to hear how your daughter does with her puppy. It sounds like this may be an easier task for her since she has a natural ability with dogs. Keep me up to date. I hope he will work well for her so she can continue in a job she likes.
Best wishes to you and your daughter.
Blacklime
As in: from about 20 years ago until 5 months ago. I've had a dramatic recovery, entirely due to my going on a CGM 24x7. The previous posters are correct: If you can avoid having so many hypos, then your awareness almost certainly recover A LOT.
I used to be in situations where I would feel a little funny, pull out my meter (which goes down to twenty mg/dL) and have it read "LOW". (WORSE than 20, although gthe "accuracy" down there is probably +/- 200%.) Then I'd often pass out, leading to "wife gets the Glucagon and stabs me in the leg", or friendly EMTs coming to my rescue and expressing amazement that I was able to even run a test at such a low bG, and etc....
NONE OF THAT HAPPENS ANYMORE, and I'm no longer unaware of 40s, 50s, and 60s. I can actually FEEL when I slip below about 70-80. I haven't had that ability for 15-20 years!
I got a CGM (the Dexcom STS, but you should also consider the MiniMed R/T). I used to have at least a dozen sub-50 lows every month, and I was going through 4-6 Glucagons every year... even though I was testing 15+ times per day. I'dfrequently crash, or fly past 300, while sleeping, when I wasn't awake to do tests. Now my trusty friend does a vibrate and buzz whenever it measures sub-90, or above 180. It's great when I'm driving, it'll give me a buzz and I know that I should grab a couple of sugar tabs at the next stoplight.... or, where there aren't red lights, I can just pull over and chew 'em down. I used to drive in FEAR OF CRASHING BG WHILE UNAWARE, stopping every 20 minutes for a slow and messy finger-stick.
Because I've had only a couple of hours below 50 in the last 3 months, I've recovered my ability to feel hypos... even at 70-80, I can FEEL them again.
IT DOESN'T COST $4000+ PER YEAR. My "3-day" Sensors almost always last for at least 18 days, and many other people on the Insulin Pumpers' mailing list says that they get 10 or more days from the Minimed Sensors too. So I'm expecting to spend barely $700 on Sensors for the entire year, that's competitive with the cost of all the Glucagons I no longer need. Cutting my finger-stick tests from nearly 20 per day down to about 3 per day is also a financial win, though other people with better insurance than mine might not see any financial advantage from this change.
This gadget has CHANGED MY LIFE. I think that you should RUN to your endo IMMEDIATELY, and ask him to get a "loaner on trial" from the Minimed Rep for a week. And/or buy one from Dexcom (they'll give you your money back if you don't like it.)
I'd recommend trying both, choose the one you like best. As with Pumps, some people prefer Animas, other prefer Minimed, others prefer Deltec-- and they've got good reasons why their pump is best for THEM. It's a very personal choice.
Note that Minimed has both "integrated into the pump" and standalone models which are suitable if you're not interested in upgrading or getting a MM pump at this time. Dexcom makes only a standalone-- but since I like my old non-MM pump, and there's one less thing to stick on your body, I went with Dexcom. MM is more popular, I think, but it seems that nearly every MM user uses the pump version (model 722-RT).
- - - - -
Not everyone has good results with these things-- it's hard to figure out which (IF ANY) Sensor sites will work for you, and readings on the Dexcom readings go wild if you get them wet or sweat a lot. So putting 'em on muscles which work hard and sweat is a BAD IDEA. Putting them anywhere near your Infusion sites is also a BAD IDEA. They sell oval-shaped saran-wrap "shower covers" with adhesive around the edge, they work pretty well for me when showering, but I think they'd leak if I went swimming.
Living in Reno, with no humidity, I have almost no sweat (even when I exercise moderately). The key is to keep the Sensors away from working muscles, such as your leg (quads are a bad), your frontal abdomen (abs are bad), and arms. I've been getting my great results by putting them down the sides of my torso, near the beltline (straight down from the armpit). The relatively small muscles on your sides don't work as hard as your abs and back muscles do... but I need to be EXACTLY down my side, NOT on the end of an Ab muscle group. UPPER butt cheeks might also be a good place, but I've not tried there-- I've found my spots, and with less than two changes per month, I don't need a lot of area to choose from.
I hear of many Dexcom buyers who send them back, they never find a site which works for them. But July and August are obviously the worst months for sweat problems in most parts of the Country, maybe things would go better for them at other times of the year.
And one person on the IP mailing list tells me (yesterday) that Dexcom sent her some replacement Sensors, saying that they've had some "recent quality problems". I wouldn't know about that, having bought a stack of 15 when I first bought the system (thinking that I'd have to buy more 45 days later). It'll probably be October/November before I need to buy any more.
Re: Is anyone dealing w/ hypoglycemic unawareness?
Quote:
Originally Posted by blacklime
..... I will treat an 80 or below b.g. with a 6oz juice, but often rebound between 250-350 within 1-2 hours. ...... I am careful not to over treat, but even so there seems to be no middle ground--
The best thing to use for correcting hypos is glucose tablets. Each one contains the same amount of glucose (the ones I use are 3 grams of carb each) and you will soon learn how many you need, based on the meter reading. Glucose tablets also act very fast. Glucose has a GI of 100, while orange juice has a GI of about 53. So it very much slower acting. Which is why your blood sugar continues to rise for a long time after you have come out of the hypo. With glucose tablets you quickly learn how to raise BG into the normal range and no higher.
Quote:
Originally Posted by blacklime
I give a correction and then waiting 2-3 hours to correct again if still high so I am not piggy backing the insulin. Some days I know my b.g. is fighting to raise, so then I do take insulin closer together, but test often so I know when it is on a decress.
It took me many years to learn that the higher the blood glucose level, the more insulin resistant we become. And the more insulin is required to do a correction. Conversely, as the BG falls, insulin sensitivity increases, causing the rate at which the BG is fallinmg to accelarate. There seems to be a critical point below which bthe BG level plummets - for me it is about 180. This why we are so often taken by surprise by a crashing BG level after correcting a high. And of course exercise exacerbates the whole thing as it also increases insulin sensitivity.
The bottom line is that, as a "brittle" diabetic, you have to avoid high blood sugars at all costs. Which is why I think targeting 180 to restore hypo awareness is a not a good idea. And it is why, as I said in a previous post, low-carb is the only way to go for you.
Quote:
Originally Posted by blacklime
I was eating: B. 45 carb
L. 45 carbs
snack 15 carbs
D. 60 carbs
snack 30 carbs
That is 195 grams of carb a day, which is far too much for any diabetic. Let alone one who is having difficuly controlling BG levels. In addition to being an accomplished endocrinologist, Bernstein has been T1 for 60 years and has reversed severe complications with a low-carb diet. He limits carbs to 30 grams a day (6 for breakfast, 12 for lunch and 12 for supper) and has an HBA1c of 4.5%. It really works like a charm.
Cheers,
Mark
__________________
Type 1 since 1977. On Lantus, Novorapid and Actrapid.
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Re: Is anyone dealing w/ hypoglycemic unawareness?
Rickst29
Thanks for some info on the b.g.r/t monitors. I have been talking to my health care team about this, as well as some reps for those monitors. Do you ever have any problems with infections at your sites? I tend to be very sensitive to that and have been on very high dose antibiotics to take care of the last two pump site infections. I can go no longer that 72 hours before I start having a sore spot at the site. I was hospitalized three days for the last site infection. My doc and I are concerned about having two sites going with the high risk involved for me.
also, how close is your finger stick test to the monitor? Ever had any problems with time lapse from the blood to the innerstitial fluid? My research has indicated there can be up to a 20 minute time lag. So if the r/t monitor says you are 135, it may not be actual as to what your blood is if tested in the finger. With drops in b.g. as fast as 15 minutes from 150 to 40, I was hesitant to rely on this.
These sound like wonderful tools, especially with the alarms for high and low levels. Because of having to chane every three days, the cost was estimated for me at $400.00 per month. My insurance does not cover this. If the monitors are so sensitive to sweat, that could be an issue. I tend to get very sweaty while I am working and exercizing. Also, I would be more inclined to use one if the site infection was not as big of issue, that's my #1 concern. Everything else could be dealt with. Hopefully, soon, there will be a model out the has the b.g. monitor in the same machine as the insulin pump. Two tools, one site!
But this is an avenue I have been keeping in mind. Thanks for your info and personal experience with this.
Good questions! The reason that the FDA limits the Sensors to 3 days is fear of infection. In detail: Their concern is, if you don't have a chance to see what is happening under the adhesive pad for WEEKS at a time, it could get pretty bad before you notice it.
But, there's an obvious solution: FDA's concern applies *IF* you didn't put it on with sterile techniques. If you're sloppy, your actually infected IMMEDIATELY, and the "72 hours" requirement is there to reduce the amount of time before you NOTICE YOUR ERROR.
Instead of being sloppy, you should put it on right: If the area's got hair, shave it. Then wash the site, AND wash your hands, LEAVING THE SOAP ON to give it enough time to do its work-- you see how people on TV (actors and real MDs "prepare for surgery", they hold up their hands with the disinfectant on for a LONG TIME before wiping it off.
Then wipe with alcohol: TWICE, and leave it on to kill things for at least 10 seconds total. If it dries out before 10 seconds is up, wipe AGAIN, with a clean applicator. NOW you can put on the Sensor. Since your sterile procedures didn't let anything get in there, you're nearly certain to be safe for a much longer time.
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There's another BIG difference between these Sensors and your Infusion set: The infusers are "injecting" foreign chemicals into your body. Your body recognizes the "carrier fluid" as a poisonous chemical, and mounts an immunological response at the site. After you've been using insulin for a while, your Immune System will rapidly create antibodies against these chemicals- they've become recognized as a foreign threat, kind of like the allergy response which some people have to later Bee stings, or Penicillin shots, AFTER the first one.
In the case of a shot, the needles aren't in the same place all the time, and it's just an instantaneous even with each shot. Your Infuser, in contrast, keeps dripping the offending chemicals continuously, and the site will eventually become a battleground of inflamed redness, dead white-colored tissue, and puss. But these Sensors aren't injecting anything. The amount of ORGANIC chemicals being released for white cells to encode antibodies is probably about zero. And my Dexcom Salesman told me that the metal Sensor sleeve is "fully oxygenated". If I understand this right, he meant that it's already rusted-- so unlike steel, even "Stainless" steel, there's gonna be almost no INORGANIC chemical reactions either.
If there aren't reactions or tissue damage, your body DOESN'T react. The amount of chemical interference which the Dexcom sensor causes may be, I'll SWAG, about two orders of magnitude less than the chemical interference which my infusers are causing.
- - - -
The end result is, the ONLY damage I see after almost 3 weeks is the hole (physical damage), and a tiny bit of blood surrounding the puncture. In contrast, my infusion sets are causing redness after even the FIRST day, and I even "feel" a bit of itchiness by the 3rd day (when I replace them). When I take them out, there's redness AND whiteness AND swelling AND puss.
I think that creating 2 of these tiny un-inflamed holes per month is BETTER than creating 10 of them... because the 3-day holes and the 18-day holes have always looked IDENTICAL to me. Almost all of the damage seems to be done upon the initial punch-in and the first few hours following the insertion; all the additional time seems to add NOTHING.
- - - -
YMMV! The fact that you have already had infection with Infusion sets means that you are NOT maintaining good sterile conditions/procedures when you put them in, so you need to improve your methods before you try to leave a CGM Sensor in for a longer time.
The companies can't recommend using a Sensor for longer than the FDA-approved time-- the Government will SLAP THEM SILLY and FINE THEM big bucks for such misbehavior. But you should hang around the Insulin Pumpers mailing list, or look at the Threads in the "Continuous Glucose Monitors" subject area of the childrenwithdiabetes forum, to learn more about these things from the people who actually use them.
Re: Is anyone dealing w/ hypoglycemic unawareness?
Incidentally, I gave up driving alone about 5 years ago, except for VERY SHORT trips, due to my own increasing hypo unawareness. No license or accident issues, I just felt unsafe for myself and others. CGM has ELIMINATED my problems, and given me back the freedom to travel around without calling for a taxi or handicap van. I've been driving a lot since May, with increasing confidence and skills.
(A long time ago I was a SCCA member and occasional racer, when I talk about "skills" I'm not talking about mere street driving.) And over at ChilderenWithDiabetes, another Dexcom user has put up a long post, talking about how his "little friend" is working great at Leguna Seca, a race track near Salinas California: he says the readings are RIGHT ON, even though he's sweating like crazy in his 120 degree race car cabin, wearing all that hot and heavy fire-resistant clothing.
Maybe I should put a five point driver's harness in our SUV, rip out the carpeting, weld in a roll cage? (The D.W. would just LOVE driving to work in a genuine race car interior, NOT !!!)
I have been talking to my health care team about this, as well as some reps for those monitors.
If your team is too uninformed to deal with these new machines, I THINK that you need a new team. My endo office was able to loan me BOTH devices to help me make a choice, and that was several months ago. Loaners ought to be quite common by now, especially from Minimed, which has gazillions of well-established Sales Reps.
Quote:
Originally Posted by blacklime
....I and have been on very high dose antibiotics to take care of the last two pump site infections. I can go no longer that 72 hours before I start having a sore spot at the site. I was hospitalized three days for the last site infection. My doc and I are concerned about having two sites going with the high risk involved for me.
This IS an extremely important concern. See separate post on "Sensor life" for a longer discussion. You should understand that you WILL get "sore spots" from infusion sites all the time, because infusers are injecting foreign chemicals (which your body reacts to). In spite of all the redness and dead tissue and puss, however, there should be NO INFECTION at these sites: If you allowed infectious organisms to be present when inserting your Infuser, YOU HAVE BAD TECHNIQUE and you *MUST* learn to it right.
Until you learn to do it right, two sites is twice the risk-- and using one of them for longer than 72 hours makes the possible scale of an infection much worse, DON'T consider using CGM until you can do it like a Med Student every time. Infection at the Infusion site or the Sensor is really inexcusable IMO, unless there has been an accidental infecting event afterwards, such as the Infuser being accidentally ripped out via the tubing in the middle of a Lake.
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Originally Posted by blacklime
Also, how close is your finger stick test to the monitor? Ever had any problems with time lapse from the blood to the innerstitial fluid? My research has indicated there can be up to a 20 minute time lag.
Here is a key thing to understand: when you have GRAPH, with data points every five minutes, you can treat the TREND rather than the treating the bG. So if I see that I'm 150 but dropping fast, I don't wait for the alarm at 90-- I'll eat right away. And if I'm going up sharply without Bolus Insulin already on board, I won't wait for the 180 alarm to go off, I'll treat earlier. For me, the time lag is about 10-15 minutes.
I also have pretty fast drops in bG, up to 50 points in 15 minutes. But your 110 points is REALLY fast, I don't know if either of the systems will deal with readings which fly around that quickly. Dexcom ignores really sudden changes as "errors" until they're confirmed by additional readings in the same vicinity. But in any case though, MORE INFORMATION is better than LESS INFORMATION. If you "accidentally" treat yourself up from 150 to 220 when you THOUGHT theat you were treating a 70 up to a 140, that's not the end of the world. Failure to treat a low because you haven't got a clue that it's even happening possibly IS the end of the world, and needs to be prevented at almost any cost. Whenever you unable to trust your CGM, you can do a finger-stick to find out what's REALLY happening.
My readings, when I 'extend the curve' forwards for 15 minutes, are within 20% S.D. against the One Touch at levels above 80. Below 80, it's less accurate, but it doesn't matter much-- I'm ALREADY treating the probable low. Sometimes it stays within 10% for a couple of days at a time. But my results seem to be exceptionally good, YMMV.
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Originally Posted by blacklime
So if the r/t monitor says you are 135, it may not be actual as to what your blood is if tested in the finger. With drops in b.g. as fast as 15 minutes from 150 to 40, I was hesitant to rely on this.
You don't just "Read" the 135: If you had 150 five minutes earlier, and 165 ten minutes earlier, you should PREDICT FROM THE TREND that your actual bG at that instant is about 2-3 additional readings further in the same direction: In this example, somewhere in the range of 90 (3 more readings to 105 (two readings further down), with +/- 20% on top of that. So you should be eating sugar tabs IMMEDIATELY, not waiting for it to go down any further.
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Originally Posted by blacklime
My insurance does not cover this.
Yes, it costs REAL money. We aren't rich enough to get by without it hurting our budget, but we pay it. For this household, it's worth it.
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Originally Posted by blacklime
If the monitors are so sensitive to sweat, that could be an issue. I tend to get very sweaty while I am working and exercising.
That could be a huge problem for Dexcom Sensors, although it seems to be less of a problem for Minimed users.
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Originally Posted by blacklime
Hopefully, soon, there will be a model out the has the b.g. monitor in the same machine as the insulin pump. Two tools, one site!
This comment shows confusion among the 4 things involved: The CGM Monitor, the CGM radio Transmitter, the Pump, the pump's Infusion Site, and the CGM Sensor.
Minimed ALREADY DOES put the CGM monitor and the pump in one unit: the model 722-R/T. (They also make a stand-alone CGM, but since you're saying that you'd prefer to have an integrated unit, I'll focus on this one. This pump, like any pump, is always directly connected to your body via the Infusion set tubing.
The Infusion Set and the CGM Sensor will *NEVER, EVER* exist as a single stab-in device, because the presence of high insulin levels around the Infuser will always make the readings of "adjacent" glucose detectors useless. I feel that they need to be kept at least 3 inches apart. So, you'll have TWO stabbed-in thingys.
In the Dexcom, the CGM Monitor is a unit all by itself. Unlike the Minimed Pump, the Dexcom "Receiver"/Monitor isn't connected to your body. Right now, mine's plugged into the charger, several feet away. Mine never misses readings at distances less than 20 feet of empty air, although it won't work through more than one wall, even at close range. The range might get worse as the batteries become older-- especially the battery in the TRANSMITTER, which can't be recharged. Although the estimate the life of the $250 Transmitter at about 6 months, mine is still sending a VERY strong signal after 4. When I'm puttering around the house, or mowing the lawn, it sits in a pants pocket.
When I drive, it's in the armrest storage compartment (the top is plastic and fake "leather, which don't cause radio interference). Or I put it in a shirt pocket. I don't like leaving it a pants pocket when I drive, because it's hard to pull out from there when the seat belt's covering the pocket. (I'm always belted, of course.) So right from the start, you can see how I consider the unconnected Dexcom to be slightly more convenient than an integrated pump-- it can go almost anywhere.
The other wearability advantage for Dexcom is in the Transmitter. It is tiny, and clips into the surface mount of the Sensor. So the ONE tape on your body is holding both parts, Sensor and Transmitter. Minimed, in contrast, requires their much larger Transmitter to be WIRED to the Sensor. Nearly everyone tapes the Transmitter down onto their skin, a few inches away from the Sensor. I know of one guy who is keeping around his waist, untaped, in an elastic pump holder wasteband. For people who react to tape adhesive, Dexcom clearly wins, there's only one thing to tape down. But for people who want to have just ONE big thing to look at and punch buttons on, the combined Pump/CGM from Minimed wins.
Re: Is anyone dealing w/ hypoglycemic unawareness?
riskst29
Thanks for more info on the r/t monitors. I want to assure you that I am very carefull when I change my site. Clealiness is utmost important to me when I change my site. There is another pump user in my area who has to change his site everyday because he is sensitive to the cannula and develops problems if he does not. So we are thinking that I may have a sensitivity to it. Another possibility for getting infections may be due to I have candida and chronic fatigue. These two things (usually are tired together) lower your immune system drastically, and make it difficult to fight off infections. Diet is critical in ridding your body of these, I do follow that to the best of my ability.
Here's something you don't hear of everyday, every time I paint with regular latex paint, within 2-3 hours my throat starts to swell and I have strep throat. I just finished a dose of antibiotics two days ago. I was painting last week doing a remodel in my home. If I use low oder paint, my throat gets pretty irritated, but not full blown strep. I have to decide how bad something needs painted and how many of my friends can come to help. Needless to say, I don't paint often. This has happened now 5 or 6 times. It is thought that I carry a strep virus that lays dormant until it has a trigger--something in latex paint triggers it. So it may be that this is another possibility as to why I develope infections at a site if left too long. We cannot possibly know all the functions our bodies perform, but we certainly can see the results when it does.
My healthcare team, especially my primary care giver, has specialized in pump therapy for many years and stays up to date on the latest tecnology. It was from a mm rep that I was told the combining of an insulin pump and monitor was in the works and waiting for approval. I will be seeing him in the next week or two and will ask about the things you mention as to why it would not work and get some clarification on this. I may not have understood correctly what he said-which is more likely the case-ooops!
I do get sore places and redness at my sites that never go any further, I expect that to happen for the reasons you mentioned. But puss is an infection and can turn serious very quickly. It sounds like you are familiar with the process of pump site iritants, itchyness, soreness, ect. As with all medical procedures, great care must be given when opening the skin to prevent problems. You gave a nice breakdown of how to do that. Thanks!!
I appreciated your explaining more on trends and graphs and how you use those even with a lag time. I printed this off so I can review it. I do better
if I read and reread a few times. It's nice to bounce off someone who knows from experience from what they have done whether it works or not.
I have been working with MM for the past 8 years and am happy with the pump and the options it has. I talked to an Animas rep about their monitors and can get a loaner one from them to try. I'll post if I decide to give it a try and give my opinion about it.
Thanks again for all your info, it has been very enlightening and helpful
blacklime
p.s. I tend to get he cart before the horse some days. After I posted this ,I read the info on sensor life. What good info!
Apology, then an IMPORTANT response (Animas is $#@$.)
First, an apology: You describe other events which *DO* show a problem with your immune system, not laziness or bad technique, so I apologize for being so aggressive in lambasting you about washing hands correctly (lie a surgeon and leaving rubbed alcohol on your skin for a longer time.
But everyone's skin is covered with germs, in particular Staph Aureus, which are a threat of infection when we break the skin with an inserted device of any kind. Please do be sure to give your soaps and disinfectants EXTRA time to work. If the skin surface is REALLY cleaned up, then there's NOTHING LEFT to infect yourself with.
Your immunological issues sounds similar to those of transplant recipients and AIDS pts. If you are getting infected even when using procedures I describe, then you need to replace soap and alcohol with stronger Clinic-type disinfectants. (Some are Restricted, you need your MD's help to get hold of these.)
And now my IMPORTANT response:
The Animas guy is trying to sell you the old GlucoWatch, which is IMO, and shown by study results, to be a pile of stinking manure in comparison with the new CGM systems. (They bought rights from Cygnus, and try to sell it in competition with new CGMs. I feel that this is kinda like selling a Donkey as a Race Horse.)
In a study I looked at GlucoWatch accuracy is really poor when the subject has bG below 100, and REALLY BAD when subjects has bG below 70. It spat out numerous False warnings, and even more important, failed to recognize MANY situations of low bG-- a much higher % of missed Hypos than the "old" Minimed, which in turn had a much higher % of misses than the "new" Minimed. The current R/T systems are all built from the "new" Minimed technology tested in that 2005 study.
Like blood-based meters, the CGMs have their biggest accuracy problems when bG is low. Unfortunately, this is you need them to be good. Fromthe data, I will characterize GlucoWatch as "catastrophically error prone" in this area. My own experience with the device, a few years ago, was also very unsatisfactory.
My advice is, Don't go there. He's looking for the commission money, and is either willing to risk angering a non-Animas pump user to get it, or he has no idea how bad the product really is. The non-MiniMed guy you should be looking for is is the DEXCOM rep... and if your clinic hasn't been "trained" to get on the Dexcom Authorized Clinics list, they're NOT really as up-to-date as they claim to be. If your provider didn't blast the Animas/Cygnus product as I just did, and steer you away from it, he's not keeping up with his reading.
Or maybe even worse... there ARE kickback schemes, many offices steer their pts. to particular brands for this reason. If your provider isn't discussing Dexcom, there's a problem. But if you are already on a MM pump, and you wouldn't mind the additional tape-on Transmitter, Minimed might be best for you. But you have to LOOK AT the two Devices first: See the currently active thread by Corvah, she went to all the trouble of getting it and then only after she put it on did she realize that the monster-sized "Transmitter' was a show-stopper. Heck, your office should have a loaner, you should be able to SEE something like this before you even take it home.
For her, even though she is a MM pump user, I think that Dexcom was the only one to even consider. (Although in fact, she doesn't need one of these first-generation CGMs at all, and made the right choice by simply dropping the whole idea.)
[url]http://www.healthboards.com/boards/showthread.php?p=2533852#post2533852by[/url]
riskst29every time I paint with regular latex paint, within 2-3 hours my throat starts to swell and I have strep throat. I just finished a dose of antibiotics two days ago. I was painting last week doing a remodel in my home. If I use low oder paint, my throat gets pretty irritated, but not full blown strep.....that I carry a strep virus that lays dormant until it has a trigger--something in latex paint triggers it. So it may be that this is another possibility as to why I develop infections at a site if left too long.
I've got an easy suggestion for this one- rather than take on the risk on infection, (and BTW, strep is bacterial, not viral), wear one of those replaceable cartridge home-maintenance masks-- the kind which smart people put on while handling insect killer sprays, not just the N-95 "over-the-mouth-and-nose" foam anti-particulate masks. You'll probably react to the mask itself, so open the box and let some of the chemical smells leak away for a few days before you use it. And also, wear it for just 20 minutes or so, while not working, to wear down any other nastiness in the filters and bothersome surface chemicals on the rubber of the mask against your skin. Wash your face gently and thoroughly after each use. If your face and Respiratory Sys. react too much, you might still benefit by backing down to N-95 or a "Household" foam respirator. I've seen some sold as "for painting", although I personally stick to the good full face-replaceable filter masks when I paint (or do insulation, bug spray, etc.). Home Dept, Lowes, or equivalent, about $30 for the cheapest good ones.
BTW, the puss which I describe in my own Infusion sites is not infection (bad smelling yellowish crud full of dead Staph cells, dead Phagocytes, and the like), but rather the clear fluid from a low-level antibody IR against small foreign chemicals. Nearly any IR will also show redness and whiteness from white blood cells invading the tissue to do their work, but this sort of low-level anti-chemical Response clears up rather quickly after the offending chemicals are removed, with no long-term damage... unless you left the Infuser in for WAY too long. For me, way to long is over 3 days. For others, it can be shorter.
I found that switching Insulin types reduced my IR a great deal: The Lilly "Humalog" formula, if you put it to my nose, smells a lot stronger than the Novo-Nordisk "Novolog" formula, and I get my 3rd day only with Novolog. My Sites were becoming "itchy", and showing more redness, after only two days before I switched. But YMMV, of course. For me, the new "Apidra" is slightly less reactive than Novo, but the difference ain't worth the 100% non-coverage of the newer Insulin. I stay with Novo, except when I'm going out in 100 degree-plus heat. Apidra seems to pump better when it's really hot, and I've got a couple of "sample" bottles to use at those times.
Re: Is anyone dealing w/ hypoglycemic unawareness?
I am a type II diabetic on insulin for about 2 years. I just joined 'Healthboards" and do not know how to put in a new post.
I do suffer from extreme lows, wake up at night sweating and dizzy. I need to lose weight but when I reduce my carbs - my bg drops very low. The doctor just says I have to eat when that happens. Sorry to go on so long
I hope you find the answer.
Re: Is anyone dealing w/ hypoglycemic unawareness?
This thread is in the "diabetes" forum. Go to the first page of diabetes. Just above the individual posts on the left there is "new thread". Click there and make your post. Hope this helps.
Betty
I just finished a dose of antibiotics two days ago. I was painting last week doing a remodel in my home. If I use low oder paint, my throat gets pretty irritated, but not full blown strep. I have to decide how bad something needs painted and how many of my friends can come to help. Needless to say, I don't paint often. This has happened now 5 or 6 times. It is thought that I carry a strep virus that lays dormant until it has a trigger--something in latex paint triggers it. So it may be that this is another possibility as to why I develope infections at a site if left too long. We cannot possibly know all the functions our bodies perform, but we certainly can see the results when it does.
Painting, etc. 
