Touche

Chad decided he wanted a testing kit so he can watch is blood sugar for a few days, since he's had a couple moments of what felt like crazy-low blood sugars (we tested during one of those moments once and it was something like 46!).  He also had a fasting blood sugar on the upper side of average when our GP tested it 8 or 9 months ago, and I think it's smart for anyone with any risk of diabetes to test their BG once in a while.  So I picked up a Relion Micro and box of 50 strips.  This was cheaper than if I'd just gotten him a vial of strips for the Freestyle I have but no longer use, or if I'd picked up strips to let him use my spare One Touch Ultramini (if I could find the damn thing!).

(I'm normally not one to promote Walmart, but their Relion meters and strips would be an great option for someone with diabetes and no prescription plan.  This is actually the second Relion meter I've ever purchased.  The first one served as a back up when my very first vial of strips ever ran out well before I could get the refill covered by insurance.  Later, I mailed it to someone I'd talked to online who didn't have insurance and was having trouble affording strips for the meter she already had.  When Chad said he thought he might want to keep a meter with him to test for lows, I didn't blink an eye at picking up another Relion.  Even if he never touches it again after a few tests, it's such an affordable backup to have around.)

When I got home, we got the meter set up.  He did the settings and learned the buttons while I set up the lancer and little meter case then nommed a PB&J sandwich.  ;)  Finally, he was ready to do a practice test.

He's seen me do it hundreds of times, and he's tested out of curiosity at least a couple times before.  The only direction I gave him was to wipe off his finger with an alcohol pad because he hadn't washed his hands since eating a granola bar an hour before.  Of course, his response was perfect:

"I was just going to lick my finger.  Isn't that what all the pros do?"

Touche, Chad.  Touche.

So he did his test and we watched the meter count down.

Me: 114? And you ate that bar an hour ago?  Yeah, that's a good number."

Chad: Funny, I totally knew exactly how to test, from watching you.
Me: Yeah, on the forums, we'd call you a Type 3 Diabetic.  Diagnosed as the spouse of a diabetic.
Chad: Haha!  That's good.
Chad pulls the used strip from the meter and holds it up.
Chad: So, now I throw this on the floor or leave it someone else's car, right?
Me: *Grinning.*  You've learned well.

Touche again, Chad.  Touche again.

The Logistics of Pumping with a Growing Belly

I realized recently that I won't have as much fatty space on my tummy once my tummy starts to get big, so I'm going to have to start using other areas for insulin infusion sites just so I can "rotate" my sites sufficiently.  Dexcom sites are only supposed to be on the abdomen, technically, so I figure I may eventually have to put all of my infusion sites on other areas if I want to keep my Dexcom in "regulation" areas.  (Plenty of people put Dexcom in other areas, but I seem to do OK rotating it on my abdomen so I haven't tried anything else just yet.)

So when I changed my site yesterday, I decided on the upper area of my butt cheek.  I've done this before with success, but it's still a little tough.  I use the Inset 30 infusion set, which works really well for me but takes two hands when removing the applicator.

First I started with the left side, and I decided, no, this is way awkward.  So I went with the right side and that was fine, but I still really had to reach in order to make my left hand available to remove the applicator.

"Crap," I thought.  "When my belly is huge, there's no way I'll be able to put this back there by myself.  Putting it on the back of my arm means no second hand, too.  That pretty much leaves the sides of my belly and the thighs, and my thighs are actually pretty muscular."

So, what?  Have Chad help almost every time?  I told him I'd probably be needing one of his hands and he agreed with a laugh.  But I really like being able to change any time I want, lickity split.  So I think my next order for supplies will be for the regular, straight insets.

I've heard they tend to kink more often than the 30s, but they're supposed to be easy and totally one-handed.

I was tempted to try the stainless steel Contact Detach set, which the local Animas trainer said is just a teeny little metal needle you push in instead of a cannula with a fancy applicator, but I have nickel allergies and have reacted to some "stainless steels."  (Stainless steel isn't guaranteed to be nickel free, just to contain so little of it and to contain it well so you're not supposed to react.)  So, inset it is.

And the long tubing this time.  I figure the longer tubing will allow me to cross the tubing over my big belly if I have to in order to hide it someplace tricky, like in my bra!

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.

Not Going Broke in an Emergency

Here's a tip for anyone who gets a diagnosis that requires maintenance medication that doesn't have a clear and consistent dosage: Make sure your doctor has either written the prescription to reflect that fact, or that (s)he is totally confident they've prescribed enough for that 30 days.

My doctor initially wrote all of my prescriptions as 30 day supplies, but I ran out of blood glucose test strips long before 30 days... and my insurance refused to refill it even when she revised the prescription.

Buying test trips out-of-pocket is expensive.  My copay for 100 strips was less than $30, but out-of-pocket for 50 of them was about $70... ON SALE!!!  (Freestyle Lite strips.  You can find them for less than that if you do some googling, but they're still a little pricy.)

Well, even that 50 I picked up while waiting to see if the insurance company would decide to cover my refill after the revision wasn't going to last once they gave us a final "no."  I wasn't about to shell out another $70 if I could find another option.

And, gosh, OK, fine, I found that other option at a store we all love to hate: Walmart.

I picked up a Relion Micro (a Walmart brand) glucose meter for $12 and a 50 pack of the corresponding strips for $20.  That's less than half of what I would have paid for a 50 pack of the Freestyle strips, and now I have a back-up meter if I ever lose or break my nice one.

Though the Relion Micro is a little more cheap looking than my Freestyle Freedom Lite, I'd done my research and found good reviews and posts about it, and found that the Relion Ultima (different model by the same company) was declared a "top pick" by Consumer Reports.  And while I say it looks a little cheap, I should also point out that the Micro is little and cute, and it comes with interchangeable colored faceplates!

Mine included a bold red option, so now I have a sexy little red glucose meter!

I bitch about Walmart sometimes, but it's times like this when I realize the value (haha) it must hold for people who who live patcheck to paycheck.  I could have gotten by with buying another pack for my pricy brand name strips, but some people could not.  And if you don't have insurance, this meter might be one of the best financial choices a diabetic could make.

I should point out that I also had the same prescription issue with the needles that go on my insulin pens.  Though I hadn't run out, I counted and knew I didn't quite have enough to make it until my refill.  Cue tons of research on whether or not reuse is safe...  And as it turns out, most people in forums said they reuse their needles once or twice and the ADA has recommendations on how to safely reuse needles:

Reusing syringes may help you cut costs, avoid buying large supplies of syringes, and reduce waste. However, talk with your doctor or nurse before you begin reusing. They can help you decide whether it would be a safe choice for you. If you are ill, have open wounds on your hands, or have poor resistance to infection, you should not risk insulin syringe reuse. Syringe makers will not guarantee the sterility of syringes that are reused.
Here are some tips to keep in mind when reusing syringes:

• Keep the needle clean by keeping it capped when you're not using it.
• Never let the needle touch anything but clean skin and the top of the insulin bottle.
• Never let anyone use a syringe you've already used, and don't use anyone else's syringe.
• Cleaning it with alcohol removes the coating that helps the needle slide into the skin easily

So I reused a few of my pen needles, and I was just very careful while removing the cap and putting it back on, making sure the needle touched nothing but my prepped skin.  I store the used  & capped needle in an empty glucose strip case, which is a very convenient size, and I make sure that I only reuse a needle for the same insulin as the first use.  I've been taking a look at the needle before reusing for any obvious issues, and I know there's no blockage since you have to push a little insulin out before you even set your dose.  I can't tell a difference in pain/comfort with that one reuse, though lots of people on forums said that more than two uses starts to hurt a little.  Those needles are so fine, they start to get dull just from passing through skin!

Also, on a related note, did you know that you don't need a prescription to buy regular insulin in the United States, except in Alaska?  It's just kept behind the pharmacy counter.  And apparently, it's not insanely expensive (someone on a forum said they got a vial for $22 at Walmart).  So if you were ever in a real bind but can scrape up a little cash, there's a way you might be able to get by.  (You should absolutely still talk to your doctor about how to use regular insulin before buying it, unless it's the kind you already use!)  Here's a chart that lays out the legality of buying insulin and syringes, by state.