One Month

It’s been one month since I started back on the t:slim pump. I have to say, it’s been an adjustment from being on the pod for so many months. I can’t believe how quickly I had become “used” to it, but I did. I was worried that I would be bothered by wearing a tubed pump again, but so far, it’s been fine.

I have been keeping an eye on my sugars as well as my t:connect account and things are going just fine with both bolusing and uploading my pump. The problems I had before with highs all day are gone, with the exception that last week was my period and things are always wacky around that time, but they’ve leveled back out and my sugars are back to their more predictable pattern, and the t:slim has been working just fine right along with them. T:connect is working beautifully, no double or triple data in there at all, and that makes me happy.

Earlier this month, I switched over to using my Freestyle Lite meter and it’s been bugging me that I couldn’t upload it. When speaking with my hubby, he made the point very simply that if I had more money in strips than the cable, then I needed to order the cable. I currently have about 3 more months worth of strips left, so indeed, I have more left in strips than it would cost for the cable… so I broke down and ordered one last week. It finally came today and I’m shouting “hallelujah” because my reports are finally looking right since all of the data is there. 

Speaking of t:connect, there are still some glitches in the system, but I’ve heard through a little birdy that there is going to be a software update release next month, so I’m hoping those will be fixed. I’m also hoping they will have the ability to upload the Dexcom for a more complete picture of what’s going on, or at least more types of meters (like the Nano), but that’s not confirmed at all and is (I’m sure) a simple daydream for now, so do not quote me on that at all.Image

I’m so glad that Tandem has come out with more colors of the t:clip during this time as well. I was hoping and praying they would have the teal one voted in as a new color, and it was! So welcome to my new design, complete with teal-clip-cased t:slim!

Also, I may add a page later for questions that you guys can submit to me about the pump or anything diabetes related, so keep an eye out!

Clothes

The hardest thing I’m learning to live with now is where and how to wear the t:slim. The t:clip case, as I’ve mentioned, is not the best made thing in terms of where the clip is placed, but it is a good protective case. For the most part, my pump stays clipped inside of my pants pocket or waistband. Other times, it’s in the side area of my bra under my arm (which is when I’m super thankful for the slimness of the pump because unlike the other pumps I’ve worn, I can barely feel it there, and it doesn’t look too much like an extra boob).

This summer, I went shopping at my local Belk store to hopefully find some shorts that fit my odd-shaped body. Jean shorts are too thick to adjust the waist in and for the most part, they stick out too far in the back. I also hate having to wear a belt, so those are out of question for me. So, I tend to go towards the Bermuda-length fabric (non-print) style with the no-gap waste band. These, I can wear for weekend and work, so I’m all for.

But the main thing I love about these? They have a decorative “coin” pocket. Nothing much can fit in them unless they’re made to carry a few dollars or a credit/debit card, but it just so happens that my t:slim fits PERFECTLY into this pocket! So I can wear the pump “naked” in the pocket and no one sees a pump clipped to my side.

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Breakfast’s a Witch

I’ve done very well so far on my t:slim with lots of tweaking here and there. I’m actually excited about using it again.

But there’s one thing that gets me… every.single.day.

The b word.

Breakfast.

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Without fail, my BG will be great until an hour or so after I eat. Everything looks great, I’ve prebolused at least 20-30 minutes ahead, my meal doesn’t spike with in 30 minutes after eating like usual.. and BAM! It hits. I end up correcting every time, so I’m thinking I need a higher insulin-to-carb (IC) ratio in the morning for breakfast than any other meal.

It seems that I’m slowly ironing out the bumps here and there. But it’s also as if I get one ironed out and another one pops up. But that’s life, right?

Cartridge Changeout

IMG_5576Last night was change-out night. I had 33 units left in the pump, but I could tell the site wasn’t working quite as well. (Not to mention, the 300+ bg sorta gave it away too.) And it was a good thing, because the pump site area was a hard lump when I pulled it out, so it was good that I did.IMG_5577

So, spurr of the moment, I decided to make a video. I’ve done this before, but I decided to do another one for the blog. 🙂

The Clip

Oh the t:slim’s clip. Sure, shortly after the initial setup was released that included a very bulky t:case and t:slider (which I do use sometimes, but not very often at all), they came up with the t:clip. A slider case with a clip attached. This was a great improvement over what they had… but it’s still lacking in my opinion.

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Really, it’s just one complaint. The clip doesn’t clip the pump far enough down to make it a steady hold. I’m constantly making sure my pump isn’t leaning forward or about to fall off of my pants/skirt/whatever. And it’s absolutely terrible for those of us who wear the pump clipped “between the girls”.
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So, please Tandem.. redesign the clip. Below, I’ve attached a photoshopped clip to include a redesign that I feel would work. You would still have two pieces (great for those who like to mix/match still too!) but the connection would be more towards the middle, allowing the smaller piece to be longer and thus the clip being able to be higher.

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The Weekend

weekendThe weekend was pretty rough, with no rhyme or reason to most readings. On the “purple” day (which was actually Saturday, not Friday… my Dexcom had the wrong date when I uploaded it), I woke up with a high BG and simply could not get it down. So, I changed out my cartridge since it had been since Tuesday that I had it in there, and my BG plummeted by 4pm. It’s not been bad since, even through my son’s birthday party yesterday.

I’m constantly tweaking things in the pump as well as around that I do (like no eating-meals/snacks-too-close-together) and watching how the insulin affects me so that I’m not overbolusing/stacking if I do eat a meal then decide to add a bit more on for dessert. I still worry that charging more than once or twice during a cartridge use will cause the pump to heat (thus causing the insulin to go bad). I may be completely wrong, but it’s still something in the back of my mind. I’m going to try giving it one good full charge and see if I can get at least 4 days out of a cartridge (since Novolog is approved in insulin pumps for up to 6 days, that way I can change out my infusion site in the middle of the wear time).

Overall, I’ve been happy with the t:slim again. I’ve still got some things I need to work out, but it’s been a good choice so far.  

Day Two

Day two has passed with similar results as day one, though I did have a few highs in there… which are to be expected since, well, you know… I am diabetic.

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Something my endocrinologist said to me stuck with me when I went for my visit last week. When discussing bolusing for supper, he told me that I probably needed to be “combo” bolusing anyway because, physiologically, it makes the most sense in order to mimic a healthy pancreas. So I’ve been thinking…. Did my endo actually make sense? Did he actually suggest something beyond his usual “lets just adjust your basal and see how that works”???

Since then, I’ve been using the “Extend” feature in the pump. Depending on the meal, I deliver a percentage immediately and the rest is delivered over a period of time that I set. So, for things like pizza that we had last night, I did a 30% up front and 70% over 3 hours. It worked then, so we’ll see the next time we have it (which is typically Wednesday nights). And, instead of only doing it for supper as he suggested, I’ve also been working with lunch too, though not quite as much of an offset. I’m learning how my body needs the insulin delivered, and the t:slim makes it easy.

My next mission is breakfast. Unlike lunch and supper, breakfast hits my blood sugar like a ton of bricks. So I need to figure out how to handle it.

First 24 Hours

Technically, it should say 36, but we’ll roll with 24 for now.

I have been doing a LOT of changes. Basal rates, insulin-to-carb ratios, lots of temporary basal decreases. It’s been so WEIRD how my insulin needs change between the t:slim and the Omnipod. I’ve been watching it like a hawk. Bolusing before meals, combo bolusing meals that usually give me trouble, spacing meals out evenly… because for once… it seemed to finally work. I owe that to Tandem’s delivery system I think because of the way it delivers. Does this mean every day will be all rainbows and unicorns? Nope. It’s already proving that to me this morning. BUT I do believe that maybe I honestly do have a lot of work to do. Accomplishing what’s happened was no easy feat, and I realize it won’t happen all of the time, but IF I can somehow get close to it on a daily basis and figure out how my body works enough to make it happen, I’ll be a happy camper.

Before it went away, I snapped a picture. I’m hoping this will give me the encouragement to stick and work with the t:slim diligently. My first 24-hr “no-hitter” in ages…..

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The Restart

I have had a Tandem t:slim insulin pump since December 2012. After just a few months of using it, there became things I liked and disliked, with the dislike list growing. Being a person with many insulin pumps, I decided to abandon the t:slim and use another one.

Lately, I’ve been thinking differently. Maybe it’s not just the pump, but the operator too (in other words, ME). My husband ( a tech guy ) has a saying when he’s irritated with people who think it’s the equipment that’s wrong without it being used properly. He calls it an ID-10-T problem. If you look at it fast enough, you’ll see what it means.

Also, at my most recent trip to my endo’s office, my endo’s nurse did something that struck me. I had been on the Omnipod for the summer months, but she assumed I was on the Tandem t:slim since I had just gotten it back in December. When I told her about the summer pod break, she had a look as if she was irratated with me. She’s never had that before in all the years and all the pump change-ups I’ve had.

So it got me to thinking… maybe I’m a bigger part of the problem than I realize. And, instead of boring people with a timeline on my main diabetes blog, Sugabetic.me, I thought I’d write out my own personal thoughts, victories, frustrations, etc with just the t:slim on here. I know it’s probably confusing, and it’s totally okay if you don’t want to follow. This is here really just for my reference  as I make this journey once more.

******Disclaimer: Any thoughts, views, and treatment options that I choose to talk about here are strictly for my own personal use. I am not a doctor nor do I pretend to be one. Nothing written here is intended to be in any way, shape, or form a suggestion as to options for your treatment. Always check with your health care professional before making any changes to your health care options. Thank you. **********

The Forbidden

When I switched over to the Tandem t:slim insulin pump, I knew I would have to switch insulin as well from Apidra back to Novolog, which was fine with me. I had used Novolog successfully during my pregnancy with a bit of extra work. So, I started t:slimmin’ with Novolog and things worked out great.

But if you know anything about me, it’s that I’m a curious cat. As it is told in the Tandem t:slim manual, it is only approved for use with Humalog and Novolog, not Apidra. Why, I’m not sure, but I was told that it’s simply because they didn’t use Apidra in their testing trials. And LOTS of people were not aware of this before switching over or starting on this pump, and had lots of trouble with occlusions and such, which promptly disappeared as soon as they switched to one of the approved insulins. So, I wanted to try it for myself. Glutton for punishment, some would say, and yes… I guess you could say that…but…

Apidra Tslim

 

I did it anyway. And I have been for the past month. I don’t know why I’m able to use Apidra and others aren’t, but I’ve been working on a theory….

One thought is that the heat from charging the t:Slim damages the Apidra since it’s not stable in heat. I have been charging my t:slim about twice per week, and when I do, I place it on a refrigerated (NOT frozen!) cool pack for the time that it takes to charge. Whether this is the “cure” for it or not, I don’t know, but I’ve been successfully using Apidra for the past month with no issues.

Another theory I have is geographic location… or sea level…or atmospheric pressure…. maybe that’s what I’m thinking… I don’t know.. I’m not a scientist (though I would LOVE to be one) but something else has got to be happening for others to have such an issue and not having success with Apidra in the t:slim. I really hope this can be figured out. I think the t:slim is a great insulin pump and could be used by a lot of people (well, a lot MORE people) if Apidra was a good, stable option.

What’s the point of this post? I’m not quite sure. Other than to be another testament to just how much of a diabetes geek I am. :)