Friday, December 24, 2021

In Which All I Want for Christmas Is Diabetes Technology That Works Consistently

 It's almost Christmas, and my family is now at my parents' house in Michigan. It's nice to be back, after skipping last year due to Covid concerns. Of course, the pandemic is far from over, but at least everyone here has been vaccinated. However, I'm not going to subject you to a rant detailing my feelings about how this pandemic has been massively mismanaged, as much as I might like to. 

This year Kittygirl has take on more and more of her own diabetes management. Overall, she's done really well. We still handle nearly everything when we're with her, but she's in charge at school and when she's with friends, with support via text or phone from us when necessary. The only times things have gone really wrong have been when the technology has failed in some way.

Two Christmases ago I wrote that all I wanted for Christmas was a closed loop system. Kittygirl's doctor approved that about six months later. It's not perfect, but it really is helpful. We learned just how helpful this fall when Kittygirl's Dexcom sensor failed while she was at school. I told her to just check her blood sugar with her meter at lunch and we'd put on a new one after school. By the time school was out, her blood sugar was in the 300's. I'm still not sure what happened to drive it up, but if the system had been working her pump would have increased her insulin and it wouldn't have gone nearly so high.

If that was just an isolated incident it wouldn't seem so bad, but the fact is the sensors fail before the 10 day mark pretty regularly. The good news is the company has a nice replacement policy and will send you a brand new sensor if you report it. The bad news is we have to report it at least once a month. This means the pump doesn't get data from the sensor while the new one is warming up. Which isn't horrible if we can plan for it, but is super annoying if, say, the sensor has failed overnight and insulin dosing for breakfast doesn't work well.

Yesterday we experienced an example of what many people agree is the weak link in any closed loop system, the pump inset. That is, the little tiny part of the tubing that goes into the body and is replaced every three days. All the insulin the world won't bring down blood sugar if the inset fails. I don't know how it happened, but yesterday we noticed blood in the tubing when we changed the pump cartridge. We weren't due to change the site yet, and blood in the tubing has never happened before, so we just looked on it as a curiosity.

The sensor had been spotty all day, and we finally decided to stop it and put on a new one. At the time, the last point recorded was 208. Which is out of range, but not super, super high. We gave a correction with the pump and thought nothing of it. After a sensor is put on, there's a two hour warmup period during which there's not data. We sometimes check with a meter one hour in, but not always, and yesterday we didn't check. We regretted that when the first data point when the sensor came back was HIGH, which means over 400. On the meter, it was 447. We realized pretty quickly that it must be the site. We changed it, and Kittygirl's blood sugar came down overnight.

It wasn't the end of the world, but it was super annoying. There are systems being tested that will control insulin delivery without needing any input from the wearer. That sounds like a great idea and I'm sure it will be great most of the time, but it will still have the same problems the currently systems have. It will only be able to do its job when all of the components are doing their jobs, and those components fail way too often. I'm grateful that diabetes technology is constantly evolving and improving. It really does make the lives of diabetics easier.  What we really need is the next advance in biological treatment.

Just for fun, here's a picture of a gingerbread birdhouse that Kittygirl made with her aunt yesterday.




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