Will there ever be a cure?

Will there ever be a cure?


It's a hot topic on D forums and blogs.  I think I most often see people say something like, "Probably, but not in my lifetime."

I'm not a naive and wishful thinker, but I'm not as jaded as a lot of veteran PWDs yet.  I haven't heard the repeated "just 5 more years" from multiple doctors.  In fact, I haven't heard that even once from a doctor (and I'm glad, because I don't think there's any way they can promise something like that right now).

My point is, I think it'll happen.  I don't actually know when, but I wouldn't be shocked at all if it happens in my lifetime.  (Not shocked, but ecstatic!)  If an actual cure doesn't happen, I am confident that diabetes care will be improved so significantly that it will almost be as good as a cure.  Maybe we won't get our beta cells back, but maybe we'll only have to give ourselves one or two injections a day to achieve healthy, steady blood sugar levels.  (I'm looking at you, SmartCells Inc.)  Or maybe someone will figure out how we can be given new beta cells that our immune systems won't attack on sight. (Russia, bravo for fearlessly exploring that frontier!  And you scientists at Washington School of Medicine, keep it up!!!)  Or maybe after the artificial pancreas becomes a reality that can be continually improved upon, someone will also develop an even faster acting insulin to pair with it, and that artificial pancreas will be developed to the point where it can function real-time based entirely on the rise and fall of blood glucose (with no need to enter carb values or temporary basal rates).

I just see so many promising ideas.  Any of these could be the development to change the lives of PWDs forever.  Maybe no one is going to hand me a pill that will cure my diabetes next year, but I do think I'll be given some life-changing treatment options in my lifetime.

In Which I Say BACK To Dexcom, "???"

I've had my (non-trial) Dexcom since Thursday evening. The first sensor was crap, apparently. The trial one from the previous week had gone so well (after the first night, which was crazy), but this one seemed to give me numbers not even remotely related to the ones my meter showed me (Dexom 44, meter 126?! Dexcom 250, meter 160?! ), and it gave me ??? errors a couple times, plus a long and inexplicable out-of-range error... so after another insanely inaccurate reading followed immediately by ???, I finally ripped it off and started a new one Sunday afternoon.

I also wasn't especially pleased with the new sensor the first day and started wondering if it could be the transmitter or receiver... until that evening, when everything started going smoothly. And now, it's damn near perfect, staying well within the acceptable variations (20 points off on the low side, 20% off on the high side). Even over the first night (which gave me trouble on the trial sensor), it didn't throw me any usual numbers, and my fasting numbers matched pretty closely.

Ahhh, CGM bliss. I'm hoping Dexcom will replace that crazy sensor (I tried contacting them, but you know, it's Labor Day weekend). In any case, I'm once again so glad to have this tool. It's just too useful... when it works.

Dexcom, Weddings, and Alcohol

I absolutely love this thing.

It's a Dexcom reciever. Part of a Continuous Glucose Monitoring System. The sensor and transmitter are pretty small, and currently attached to my abdomen. Every 5 minutes, the Dexcom gives me my glucose levels.

These are not yet accurate enough to totally replace traditional glucose meters. Before you ever give yourself insulin based on your current BG, you have to stick your finger. But the number on the screen isn't what's so awesome about this device. What's so awesome is that you can see where your blood glucose is going!

Three examples of when I loved this thing this week:

Wednesday: I was driving to an appointment when Dexcom buzzed to tell me my BG was dropping fast. I knew (and it showed) that my numbers weren't high enough to stand such a quick drop for long, so I chowed down on some glucose tabs. 5 minutes later, I could feel that my BG was getting low... but very shortly after that, the glucose tabs kicked in and I felt better, and Dexcom showed my BG starting to slowly rise to safer levels.

Friday: At my birthday party, I decided to have some wine. I rarely do this for fear of what it'd do to my blood glucose levels, but I had Dexcom to tell me about any sudden drops... which I did not have. Dexcom gave me a view of my BG trends all evening, and I kept it where it would wake me if I went low during the night. I didn't have to stress.

Saturday (last night): I went to my cousin's wedding with an already elevated blood glucose due to eating fast food for lunch. At the reception, I gave myself insulin and made myself wait until Dexcom showed my BG starting to lower before beginning to eat my dinner (thus avoiding an even worse spike). This meant that, when it came time for cake, I didn't feel horrible about eating sugar. Again, I took my insulin a few minutes before eating the cake and saw that my numbers were starting to come down slightly before I ever put the first bite in my mouth. In fact, after that cake, I finally saw my numbers begin to return to a healthy range. Then, about three and a half hours after the cake, Dexcom buzzed me and showed a sharp drop in BG. What?! I tested to confirm and yes, I'd had a sharp drop. Aided by Dexcom (and the occasional finger stick to confirm whenever I was shocked to not see a rise in BG), I started consuming carbs. A small cookie... nothing. Another cookie... nothing. A 10-carb box of apple-carrot juice... A slight drop?! Glucose tabs... a slight rise, so wait and see.... no change? Finger-stick shows a BG of 88, which is too low for bedtime with such a downward trend and the knowledge that I'd had alcohol two nights in a row! I ate a 16-carb South Beach bar and sleepily watched Dexcom's numbers rise to almost 100 (with a slightly-upward trend arrow) before nestling it next to me and going to sleep. Dexcom shows I reached the 190 range in the night (which, I've discovered, means I was probably closer to 170 or 180), but the glucose meter showed me a 112 (Dexcom showed 130) when I got up late in the morning. I'd rather not go that high, but I think two evenings of alcohol threw my system through a loop, and it was necessary.

I've found the Dexcom numbers off by 20 points pretty often, but it's been an invaluable tool already. This was just a "trial" week, required by my insurance before they'll actually cover Dexcom, and I'm now more convinced than ever that I want one. It's helped me learn more about the timing of my insulin (I'm now trying to take it 15 minutes before I eat, when I can, to avoid spikes) and has helped me live a slightly more normal life (normal for me!) without worrying that I'd have a middle-of-the-night emergency. (I also learned that something last night didn't work for me. Was it two nights of wine in a row? Or did I guess horribly wrong about the carb content of cake? Or did even that small amount of dancing bring my BG down? I'll now have a much more watchful eye on all of those elements until I figure out what the problem was.)

Dexcom, you rock.

Smoothing Out the Seams

I think I’m beginning to incorporate diabetes treatment into my life more smoothly. Even with the pump being so new, and even with other new things (CGM) on the way, it’s all starting to blend in. All of the actions are inspiring less, “Let me stop my life for 5 minutes to test my blood sugar and take an injection,” and more, “I hope I don’t look too inattentive while I test my blood sugar and listen to this person talk at the same time.”

The most invasive daily activity at this point is counting carbs, even though the pump takes care of some of that for me. Even if the database were easier to browse, some foods are just always a mystery unless you make them yourself. There could be sugar in your sweet corn, flour in your omelet, or (on the flip side) far more fiber in that dinner roll than is typical. And what is the tuna-to-pasta ratio in that tuna casserole??? It helps, when dining out someplace without a nutritional guide, to stick to simple foods. I’ve been eating a lot of poultry and seafood with rice and veggies or salad lately... The meat has little to no carbs (as long as it's not battered, and depending on sauces and glazes!), I can pile rice or veggies into a mound and judge which of my measuring cups it would likely fill, and side-salads with creamy dressings (ranch or Caesar), a few croutons, and no fruit have pretty reliably acted like about 10 or 15 carbs (depending on size). I’ll probably branch out into more combination foods as I get a better feel for carb content, but simple and familiar foods make life a little easier when there are no hard numbers to rely on.

Making food at home is easy. Meals for just myself are usually packaged and frozen (I love Kashi meals for lunch!) or routine enough that I know exactly how many carbs are in the final product as I always make it (my usual PB&J sandwiches are 34 carbs). If it’s a more complex meal for my husband and I, I usually try to cook exactly enough for both of us. I jot down carbs on a scrap of paper as I choose ingredients, total it up, then divide by two to determine the carbs in my half of the meal. (Or, more likely, I take a look at the carbs for one serving of a frozen “meal for two” I’ve just sauteed!) I test my blood sugar while the food is in the last couple of minutes of cooking, then punch the carbs into my meter-remote for my bolus calculation as soon as we sit down to eat. I’m already eating the first bite before the pump has finished its bolus. (So much faster than taking a shot!)

So it’s all falling into a rhythm. I’ve had to make some adjustments to my routine to more seamlessly incorporate treatment (eating simple foods at restaurants without nutrition guides, taking a few extra minutes every third day to put insulin in my pump and insert an infusion site so I don’t have to take a shot 5+ times a day, buying a more organized purse to easily carry and find my gear, buying some 1-cup tupperware bowls so I know exactly how much cereal I’m eating without breaking out the measuring cup...), but the treatment itself is also becoming easier to adjust (the pump means less time and mess before meals, I can use my glucose monitoring kit more quickly and without taking every little thing out of the case now that I’m used to it, and I don’t have to do as much math to give myself insulin anymore).

I still have these surreal moments when I realize, “I’m diabetic. I have a chronic disease. I have to take medicine multiple times a day to stay healthy and alive.” This strikes me especially hard when I wrestle with the tube of my pump while changing clothes, but then the pump disappears quite effectively under the front of my bra, and I only occasionally talk to it for the rest of the day through what looks pretty much like a fat little PDA... and it talks back to me from beneath my shirt through the quietest whisper of a *click* when it gives me a basal dose of insulin, and through a rhythmic vibration that translates into, “Bolus insulin for 41 carbs coming right up!!!” And I can hear the quiet twist-and-deliver as I enjoy the first bite of my meal... and then I think about other things.

Every now and then, I’m amazed by the things I do automatically. The seams are smoothing out...

Pumping It Up!

OK, so here's the pump update!

I started on Wednesday. The frustrating thing is that the CDE, who I had never met before, kind of started from scratch on a lot. Like, though I knew I needed lower basal rate in the afternoons and evenings, she still set the same rate all day. Maybe that's standard for starting on a pump, but I kept wishing my usual CDE were there instead.

But, over two hours (which could have been more like one hour, if she weren't such a chatter!), she got me started and set up. I was nervous about inserting the needle/cannula for the infusion set, but discovered that it hurt less than some of my insulin shots do! It was a little awkward, but generally easier and less invasive than I thought it would be. My mom, who went with me and is a nurse, was concerned that the cannula was too shallow and started making suggestions about angling it differently next time... But the CDE assured her that it was in exactly right, and my later numbers showed that the insulin was indeed getting into my system properly. Pretty cool.

This really is kind of like starting from scratch, though. The CDE seems pretty happy with where my numbers have started (some people's blood sugar does crazy stuff when switching treatment methods!), but we're still having to adjust for evening and afternoon lows. A total pain. But it's interesting to watch my insulin needs go down so much on the pump! She commented that they start a new pumper on a slightly lower basal rate than they'd had because most people weren't getting every little last drop in their system when doing shots. And I believe that, because I usually saw a remaining drop (maybe two) come out of my pen needles even after the recommended count-to-ten.

Wearing it has been no problem. It's a little surreal to be hooked up to a medical device, but it's small and cute. So far, I've worn it:

• Clipped under the middle of my bra (I'm glad I'm endowed, now!).
• Under my waistband.
• In my pocket.
• Clipped inside the front of my nightgown (around the house and in bed).
• Clipped to the side of my underwear (in bed).

(Under my waistband.)

Pretty simple. I dig it!

Dexcom on Its Way!

So not only am I getting an insulin pump, but I found out today that I've been approved for the Dexcom continuous glucose monitor (CGM)!

I was skeptical my insurance would approve it, because it's still so common for people to get turned down, but I'm betting the pregnancy planning is what won them over... though Mom pointed out that my situation is an unusual one, even if it's not uncommon, so they may have been prone to approving it for someone with a brand new case of Type 1 at the age of 30. She also thinks insurance companies are catching on to the fact that good treatment now is usually less expensive than complications down the road.

Caremark and BCBC of Oklahoma, your recent moves to benefit my health and treatment plan are starting to shake my whole insurance-companies-are-evil stance!

While the pump is very exciting, I'm even more excited about some of the benefits of the Dexcom. First of all, it'll warn me about lows and highs, sometimes even before I think to test for them. And I find that, while I feel most lows before they get bad, I haven't really tuned into the symptoms of highs yet. I don't pee like crazy, my thirst isn't unusual enough to tip me off, and I don't feel that "off," which I attribute to having recently spent so much time with even higher BGs as an undiagnosed diabetic. Highs just feel like more of the same to me. But now, Dexcom will buzz me when things are climbing too fast.

And, in tandem with the temporary basal options the pump gives me, I think this technology will let me exercise and be otherwise physically active without worrying as much about lows anymore. If I take a sudden nose dive, Dexcom will most likely tell me.

Badass.

Robo-Pancreas!!!

Look what I have...

That's right, I have an insulin pump!!!

It's an Animas Ping... A pink Animas Ping! I used to hate pink, but I now really appreciate it when it's an unexpected color... like in the case of a medical device.

I'm not using it until Wednesday, when I'll meet with my CDE and get the official "training." I've been playing with the functions, with a cartridge and tube full of water. Tonight, per my CDE's recommendation, I'll tape the tubing to my stomach (pump attached) so I can figure out how I'll want to sleep with it.

Aside from how awesome it is that I'll soon have more precise blood sugar control and will just have to push buttons instead of giving injections in public (not that it's embarrassing, just a hassle), I'm totally drawn in by the fun that comes along with a pump! It's a medical device, yes, but it's a gadget. It's advanced, cute, and it makes fun noises! Oh, oh... AND IT DOES MATH FOR ME!!! Sold!!!

I keep reading about T1 girls struggling to "hide" their pumps, and I'm sure I'll get tired of the questions and start tucking it away into my bra, but I currently have no anxiety over the prospect of it being visible on my everyday outfits. It's cute, and I imagine a lot of people will assume it's an MP3 player of some sort. For those who ask, my current plan is just to tell them and to answer any other questions.

I should also comment that my insurance has all worked out remarkably well! Blue Cross Blue Shield approved this earlier than their policy normally allows, and Caremark agreed to cover vials of Novolog for me right away even though I very recently refilled my prescription for the Novolog pens (technically, this was like trying to "refill" my Novolog prescription too early). I still think the system needs reform, but I have to say that I'm pleasantly surprised by how relatively few roadblocks I've hit.

And, in general, I have to say things are pretty good right now!