Friday, January 23, 2009

Obama health care reform seems promising

If you're like me, you've been watching Obama with interest, particularly to see whether he will follow through on his health care reform promises.

It certainly seems he will. This article on Obama's stance on the issue of health care reform indicates that his campaign promises were serious statements of intent. Even once he was elected, Obama continued to set the stage for his plan to make some major changes in the health care industry. And now he's pressing for health care to be a significant issue in the economic stimulus bill he and Congress are working on.

Obama has been amazing, in my opinion. Even before he took his oath, he was acting like the president, talking to foreign leaders and addressing the public's concerns. And after he was sworn in on Tuesday, he hit the ground running: In his first full day as president, Obama accomplished more (in my opinion) than Bush has in the last six months.

All of this seems to indicate that President Obama will also keep his promises regarding health care. Good news for those of us with preexisting conditions such as diabetes!

Tuesday, January 20, 2009

A happy day for diabetics everywhere

Happy Inauguration Day! Today Barack Obama was inaugurated as the 44th president of the United States. Since part of his campaign platform was health care for all Americans, an issue I feel very strongly about, I am excited to see what change he will bring to our nation's health care industry.

Although in his auguration address, President Obama (doesn't that sound wonderful!) didn't refer specifically to his plans regarding health care, he did hint at the change he intends to bring about in this area:

The question we ask today is not whether our government is too big or too small, but whether it works — whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified. Where the answer is yes, we intend to move forward. Where the answer is no, programs will end.

It doesn't take a genius to know that the current health care setup is NOT working, so I'm sure that's part of the change he is referring to here. I'm looking forward to seeing what he will accomplish as president!

Sunday, January 18, 2009

Coping without the Navigator

My life is returning to normal somewhat since I've been without the Navigator again. I don't have to worry about keeping the monitor within range at all times, or be careful not to inadvertently scrape the sensor off my belly.

On the other hand, I really miss having that graph of my blood sugar over time. It's so amazing to see the curve of my blood sugar as food and insulin take effect!

I do seem to have found the correct nightly dose of Lantus, however, as my sugars are easier to control, more often in the normal range, and are much more manageable in the mornings when I get up. Also, as I was hoping would happen, my week with the Navigator has inspired me to check my blood sugar a little more frequently, and take a little better control of my diabetes. Amazing what just a week of using a continuous glucose monitor has done for my understanding of my diabetes!

Wednesday, January 14, 2009

Making the Navigator sensor last longer

I have a confession to make: I kept the Navigator sensor in for two extra days — for a total of seven days instead of five.

The sensor adhesive was sticking so well, I was pretty sure I could get away with it. And I didn't have any problems with the accuracy, either. In fact, I'm not really sure why they want you to only use the sensor for five days.

To get the extra couple of days, I stuck my thumbnail into the back of the sensor and popped the catch that keeps the transmitter locked onto it. You have to be very careful when you do this, so that you don't wreck the adhesive or pull the sensor out of your skin. You might want to look at how the sensor and transmitter fit together sometime when you removed a used sensor, so you know what I am talking about.

Anyway, when you do this you really only get an extra day and a half, because you have to go through the 10-hour initializing period again. But in my case, I wasn't as concerned about my daytime sugars — I wanted to fine-tune my Lantus dose by looking at my nighttime sugars — so I just restarted the sensor shortly after I woke up on Monday.

I ended up being glad I did it. I was able to tell quite a bit by looking at my sugars Monday and Tuesday nights, and I think I've hit on the correct Lantus dose. It was going so well, in fact, that I was really tempted to leave the sensor in for longer — but not knowing what would happen, I reluctantly removed it this afternoon.

Sunday, January 11, 2009

Making the Navigator sensor stick

In my last post I talked about the Navigator sensor adhesive problems I had when I participated in a CGM study back in July.

This time, luckily, I haven't had the same problems. I think this is because of one or more of three possible reasons:

1) It's the middle of winter and I'm not as active as I was over the summer. At the time of the study, I was cleaning stalls at the barn in exchange for free board, and I was riding my horse frequently.

2) I'm not sweating as much. I think sweaty skin was the primarily reason why the Navigator sensor's adhesive seemed to have so many problems over the summer. Even had I not been so active, it was hot! This would also explain why the combination of a bandage underneath and the Skin Tac (which I described in my last post) worked so well.

3) I've lost some weight. My tummy is flatter and doesn't curve as much when I sit down.

4) I haven't put an over-bandage on at all. I think putting a bandage over the top pulls at the adhesive ring around the base of the sensor, and loosens it, so I decided not to put any extra adhesive or tape on unless it actually started coming off.

In any case, this time I used IV Prep instead of Skin Tac. We had tried that once over the summer, and it didn't work then, but it's working pretty well now! It wasn't until the fourth day that the adhesive finally started to loosen the slightest bit at the edges. I had forgotten to put a bandage underneath the sensor (which a hole in it for the entry point), but I don't seem to have needed it this time — though I suspect the nickel will start making me itch soon!

We'll see if the adhesive makes it to Day 5!

Saturday, January 10, 2009

Navigator sensor adhesive problems

Back when I did the CGM study in July, I (and everyone else) had a lot of problems with the adhesive on the Navigator sensor. I had a sensor actually pop out, and two out of the three times, by the time we got to the end of the 5-day period I had to hold the sensor on with tons of tape for fear of losing it.

The one time I didn't have any problems with it, some mystery lady — a pump rep, I think, who didn't work at my doctor's office but was helping out — used Skin Tac wipes to make it stick. This is what she did:

1) Put Skin Tac on my skin. She said it was okay for the sensor to go through it, though I've heard differently since then.

2) Cut a hole in a clear, rectangular bandage, just a little larger than the size of the sensor and its surrounding adhesive. The hole was for the sensor wire to go through into my skin, so she made sure it lined up correctly.

3) Put the bandage on my skin, over the Skin Tac. This was actually to prevent the little spot of nickel on the transmitter from touching my skin (I'm allergic to nickel), but as it turned out it also helped to prevent the sensor adhesive from losing its stickiness when I got sweaty.

4) Put the sensor over the bandage, making sure the entry point lined up with the hole in the bandage.

Out of the four sensors I wore during the study, this one stuck the best, without me having to tape it down as the 5-day period wore on.

This time I've had a little better success, as I will explain in my next post.

Friday, January 9, 2009

First night of Navigator readings and nighttime insulin resistance?

Last night was my first real night of Navigator readings, since Wednesday night the meter was having so many problems.

The meter was about 30 points on the low side last night, but I did check my blood sugar and the difference was consistent. In any case, the meter did reveal that my sugars held steady throughout most of the night.

The one thing that did baffle me was a little bit of apparent insulin resistance that I experienced between late last night. Around 10pm I checked my blood sugar and found it was a little over 200. It had been several hours since my last meal and insulin dose, so I took a couple of units of Humalog to bring it down.

Between 10pm and midnight, my blood sugar didn't move it all — it stayed right at about 230 the entire time. So at midnight, when I figured the Humalog would have run its course (short-acting insulin takes 2-3 hours, but with me I usually find it takes only 2), I took two more units.

I was up for nearly another two hours, and when I went to bed at nearly 2am my blood sugar had dropped to around 135. I figured that was high enough to prevent crashing during the night (usually I aim for 150).

Unfortunately, my blood sugar continued to drop until about 4am. I woke up several times with the Navigator beeping at me. Since it was reading about 30 points low, it was telling me I was around 40, when I was actually around 70. However, after 4am it stayed consistent for the rest of the morning, so I can only assume my new nighttime Lantus dose of 16 is pretty much perfect.

I am going to watch the next three nights for signs of insulin resistance late at night, and I will be careful not to take two shots so close together again at bedtime. I came pretty close to crashing, even if I didn't!

Day 1 on the Navigator again

I mentioned in my last blog post, about Wednesday's appointment with my endocrinologist, that my doctor's office gave me a Navigator sensor to help me find out what my blood sugars are doing overnight. The hope is that the 5 days I get on the sensor will help me regain control over my diabetes.

The unit is mine — back in July, I participated in a comparison study on continuous glucose monitors, and at the end of the study I got to keep the CGM of my choice. I chose the Navigator, because despite the sensor adhesive problems and the size of the transmitter, I felt it was more accurate at lower levels — something that is important for me at the barn.

Unfortunately, I have been unable to get my insurance company to approve the sensors, so I haven't used the CGM since then. Yesterday was therefore my first full day back on the Navigator in almost six months.

When I first inserted the sensor on Wednesday, I had a little bit of trouble getting used to having it on me again — though I adapted faster than I did my very first time. For the rest of Wednesday I was worried about bumping it, rubbing it, etc. However, by the time I woke up yesterday morning, it felt much more natural to move around without worrying about the sensor coming off.

Because the Navigator waits 10 hours before the first calibration, it wasn't until Wednesday evening that I started getting any readings. Unfortunately, the meter wouldn't accept my second calibration late Wednesday night, so I had to get up every two hours throughout the night when the CGM beeped at me to recalibrate.

Because of the calibration problems, the meter wasn't very accurate overnight, so I couldn't determine anything based on the night's readings. However, during the day yesterday I very quickly was able to assume much tighter control over my sugars, same as what happened when I first started using the CGM back in July.

It's so nice to be using the Navigator again, even if it's only for 5 days!

Thursday, January 8, 2009

The purpose of frequent endocrinologist appointments

I haven't had very good control over my diabetes lately. My blood sugars have been quite high, and I haven't been checking very often. As a result, yesterday's appointment with my endocrinologist was a bit discouraging.

Of course, though, that's the point of seeing your endocrinologist frequently: to get you back on track when you start to stray.

One of the reasons why I was having problems was because I've been afraid to bump up by nighttime dose of Lantus by too much. The CGM study I did back in July (which I still need to blog about — sorry!) verified that I don't wake up when I crash at night. I've tried a couple of times to bump up my nighttime Lantus dose (it's been at 15 for several months now), but every time I felt like I was pushing lows all the next day, so I reverted back for fear of what my sugars were doing while I was sleeping.

Unfortunately, when combined with my recent trend toward less frequent testing, my sugars were getting quite out of control. It's easy to ignore that when you want to, so I really needed the reality check of yesterday's doctor's appointment.

My doctor's appointment gave me several things to help me out:

1) A free Navigator sensor (I was able to keep the Navigator unit after the study ended in July) so that I can find out what my sugars are doing overnight
2) Guidelines for changing my Lantus dose
3) Another appointment in six weeks, instead of the usual three months, to check my progress

So far I am really very excited about being wired up to the Navigator again, even if it's only for five days. I'll blog about that in my next post. However, the real thing that saved me here was the doctor's appointment, as it gave me fresh resolve to keep better control of my diabetes.