Mixing Up Finger Sticks and Flash Monitoring

I don’t cope well with the continuous nature of glucose data. After prolonged periods of using my FreeStyle Libre, I tend to get a little fatigued and overwhelmed. I know that I’m not getting the most out of my flash monitor, which I pay a pretty penny for. Perhaps I might feel differently if I were not an insulin pumper as well, and the Libre was the only technical device I had to deal with.

Over the last couple of months, I’ve settled into a routine of wearing a FreeStyle Libre sensor for the first two weeks of the month, and then imposing a break which sees me going back to fingersticks.

Mixing up flash monitoring with fingersticks helps to keep things fresh and exciting for me. These little breaks help me to clear my head from the constant flow of data that’s just a scan away. It helps me to re-evaluate my glucose monitoring habits, and whether I am checking my blood sugar out of necessity or simply for the sake of it. It also keeps me from becoming too reliant on the Libre, considering it is costly and not currently subsidised here in Australia.

However, I have also found fingersticks challenging after using the Libre. Over the past year or so, I’ve been learning a lot about my blood sugars and applying some of these observations towards my diabetes decision making. I usually apply a new sensor with the intent of, for example, analysing my overnight line or basal testing my work day mornings. But with diabetes being diabetes, two weeks is simply not enough to complete all of those little tasks I’ve set out to achieve.

Coming off the Libre has felt a bit like driving somewhere south of the river without directions. I’ve often found myself feeling lost in those little problem spots, anxiously trying to keep my head above water with finger sticks. By the time my self imposed break is up, I’m ready for a new sensor.

However at the moment, I find myself in somewhat unchartered territory.

I’m currently in my longest stretch on fingersticks since I first began using the FreeStyle Libre last year. There are two unopened boxes of Libre sensors on my shelf, and I haven’t felt any desire to put them to use in some time.

I don’t feel like I am struggling without it. I’ve applied what I’ve learned and observed. The problem spots are slowly but surely smoothing out, and starting to feel less problematic. I feel…comfortable.

I guess I have always perceived the Libre as a tool to evaluate elements of my diabetes management, rather than a tool to directly make my decisions from every day.

At the moment, I feel like I am where I have wanted to be for a long time.

Review: MedAngel Insulin Temperature Sensor

Earlier this year, I was contacted by Amin from a company called MedAngel. Having lived with type 1 diabetes for ten years, he began to tell me about an incident where his refrigerator completely froze his supply of insulin. From there, he created a solution to his problem in the form of the MedAngel temperature sensor.

(Disclosure: I received a MedAngel One to try. There was no expectation that I would blog about the product, and all opinions expressed here are my own).

The MedAngel consists of a small oval shaped temperature sensor, which is stored in the same place as my insulin. The sensor then connects to an app on my smartphone, and transmits the temperature of my insulin via a Bluetooth connection. 

I must admit that I couldn’t muster too much enthusiasm for the MedAngel, initially. It sounded a little…unnecessary. Honestly, I didn’t think that I needed it.

I know that insulin needs to be refrigerated when it’s not in use. It’s good for 28 days once taken out of the fridge, and should then be disposed of. I’ve often stretched out post-holiday supplies beyond that timeframe, feeling guilty to waste something that’s so expensive. However, I guess I’ve never really given too much thought to what that exact storage temperature should be.

I first learned the concept of “spoiled insulin” last year, when my levels became seemingly impossible to tame. I’m also really conscious of temperature every time I go to the beach on a blazing hot day. But do I give a lot of thought towards the safe storage of my insulin day to day? Probably not.

Two weekends ago, I put my MedAngel to the test. I placed my sensor in the bar fridge with my insulin, and connected it via Bluetooth to the MedAngel app on my iPhone. There was a list of medications to choose from, and I was easily able to find both my Novorapid Penfill cartridges and Lantus pens. I told the app that I was “Storing” unopened medication, and I was good to go.

Soon enough, the app began alerting me that the insulin in my fridge was below the safe storage temperature of 2-8 degrees. 

I spent the rest of that weekend cautiously adjusting the temperature in my fridge. When I started out, the temperature dial in my fridge was sitting inbetween “Colder” and “Midpoint.” By the time my fridge had reached a safe storage temperature, the dial was sitting inbeweeen “Midpoint” and “Warmer.”

While I suspected that I might have to make my fridge a bit colder, I was hardly expecting the complete opposite. I couldn’t believe that my insulin had been sitting at borderline freezing point for all this time.

My only negative is that I had to be in the same room as the sensor, in order to receive the temperature via Bluetooth. There was also no ability for me to manually “refresh” to obtain a new reading, but that’s just me being impatient…

The results really did speak for themselves. It was a lower trafficked fridge, and it was a really cold weekend. But still…the results were eye opening.

This is a really, really amazing product.

If you think this issue doesn’t affect you, then you need to try this product.

The MedAngel is available online, and it ships worldwide.

For those of you in Australia, MedAngel is also available through One and 2 Diabetes Accessories.

Diabetes Advocates Day

On Saturday, I was invited to be a part of Medtronic’s inaugural Diabetes Advocates Day. The event brought together a small group of advocates from around Australia at Medtronic HQ in Melbourne. Some of the advocates in attendance were familiar faces, while I briefly met others for the first time.

The day began with a coffee stain on my nice shirt and Chinos, as I discovered that my cappuccino had two lids placed on it! 

On the subject of book recommendations, I got to muse at the amount of times I get ridiculed at home for picking up a new book and not finishing it! (Yet I call myself a writer…)

Despite all of the creative minds in the room, the best hashtag we could come up with was #dAdvocatesAU, not to be confused with all the Dadvocates out there!

Going into this event, I was half expecting a big announcement. I knew full well that Medtronic’s hybrid closed loop system – an insulin pump that automatically regulates basal insulin based on CGM readings – is being rolled out in the US later this year. Although there was no announcement of the sort, we did get to hear about research currently underway with these systems from endocrinologist David O’Neal.

One of the most fascinating things to hear was the acknowledgement that overnight insulin needs can vary by as much as 200%. I only recently wrote about my own struggles, and having to tweak my overnight basal rates at least once a month.

We were shown research participant graphs of several nights where different foods were consumed, and how effectively the hybrid system was able to regulate blood sugar levels.

There were a few reactions in the room at one of the graphs, where a patient drank a glass of juice without giving any insulin for it. This triggered a very insightful discussion about placing our trust in the technology. There were advocates in the room who expressed that they felt the most comfortable and in control with multiple daily injections. Many of us couldn’t imagine not treating a hypo, and letting the pump suspend insulin delivery to stop glucose levels from falling below target. As technology advances, those of us using it will ultimately have to move past years of training we have received from diabetes healthcare professionals, as well as our own habits and tricks that work for us.

The most engaging part of the session was hearing from Eduardo Chavez, Medtronic’s Market Development Consultant. He expressed that technology is not able to adjust to real life. Our food, our sleep, and the activities we undertake during the day are often spontaneous and vary each day. That’s where the concept of Sugar IQ comes in. Sugar IQ is a real time, personalised and actionable mobile assistant in development from Medtronic. The underlying idea of this app was to make daily management tasks easier, and with less effort from the user.

Logging data is tiresome. If I’m going to log carbohydrates, insulin doses, and blood sugar readings, there has to be a clear benefit for me. While the app analysed CGM data and highlighted trends or patterns to the user, I felt that it didn’t go as far as giving the user actionable suggestions. I know that there are a lot of regulations around mobile applications giving medical advice, but many of us pointed out that it was unrealistic for the user to be able to get in touch with their healthcare professional every time the app suggested so. I also felt that the app would have been more effective if it were compatible with a wider array of pumps, meters and CGM systems. It will be interesting to see how our discussion influences the development of Sugar IQ going forward.

After breaking up for some brief group activities, the day ended with a GoPro group selfie. It was a jam packed day full of stimulating and insightful discussion. I guess my only disappointment was the lack of time to network with the other advocates in attendance. Big thanks to Medtronic Diabetes for inviting me to be a part of this event, and be sure to check out the hashtag #dAdvocatesAU on Twitter to view the discussion from others in attendance.

Disclosure: Medtronic Diabetes Australia covered my travel expenses to attend Diabetes Advocates Day on Saturday. They also put me up in a hotel on Friday evening and provided morning tea and lunch at the event. I stayed in Melbourne for 3 additional nights at my own expense. There was no expectation that I would blog about the event, and all thoughts and opinions expressed here are my own!