June endo update

Yesterday was my quarterly endocrinologist appointment and it went really well! As I mentioned here in the past, I've become increasingly interested in getting both an insulin pump and a continuous glucose monitor (CGM). I got to discuss this with the diabetes educator whom I see every visit.

Side question for other PWDs: Do you spend most of your endo appointments with a CDE instead of the doctor? I've only spent a big chunk of time with Dr. L on my very first appointment. I've been back twice now where I spend nearly an hour with her CDE (whom I LOVE) and then Dr. L comes in for a few minutes to review what the CDE has determined. Is this typical? Should I not like this? Basically all of the new treatment plan I'm about to discuss was formulated by the CDE and then OK'ed by the doctor.

Ok, back on track. Of course the first thing I wanted to know was my most recent A1C. This was my best number ever: 5.7! While that shows tremendous improvement from my original diagnosis (12.5) and even my last A1C from mid-April (6.3), what it doesn't tell you is that it's a result of glucose levels ALL OVER THE PLACE. I had been waking up nearly every day with a low, especially since I started my new exercise plan. Almost every single one of my post-lunch finger sticks showed me too high. While I am thrilled with a 5.7, I would much rather have consistent glucose levels with a higher A1C. So, we're adjusting my treatment plan to make my everyday life a little safer.

I had been taking 12 units of Lantus a day, at bedtime, and that was it. This easily explains my high postprandials since I hadn't been taking anything for my meals. I really preferred this one shot a day thing to what I'm doing now, but I know that it's better for me this way. Now, I'm taking a 6 unit dose of Lantus at bedtime and a 1 unit dose of Humalog before every meal. This means 4 shots a day now. Ouch.

I started this new plan last night and woke up with a much better number of 93 instead of my usual 60-65. I gave myself my first Humalog dose before breakfast. This is such a small dose that it seemed like I was injecting nothing. Trust me, the needle still hurt like always, but it's hard to believe so little fast-acting insulin can counteract my 45 g/carbohydrate breakfast. Plus there was a fairly sizeable drop left on my skin at the injection site. I suppose when I test in about a half hour, we'll see how well it worked.

So, even though the shots are not my friend, my CDE and endo both promised me this was the next step before getting a pump. They want to see how these doses work for me. I was sent home with brochures for three different pumps to try to figure out what I might think works best for me.

Here are my choices:

What I like about the OneTouch Ping: separate remote for dosage, completely waterproof, very small basal increments available.

What I like about the Medtronic Minimed: integrated CGM system, the company has been in business for a really long time.

Here's the final one, the OmniPod. Although this one didn't come with a great deal of information, it did come with a sample pod (no insulin, no needles). Yep, this is my arm:

What I like about the OmniPod: no tubing! I know I didn't say what I didn't like about the other two, but this one is easier since I've been able to attach it to my body. It's big. It seems like it would be trickier to conceal. I've read some reviews that mention if anything goes wrong with the cannula (the catheter under the skin) you have to replace the entire thing.

I put it on yesterday evening and so far it hasn't been too bad. I have run into door frames with it a few times. It didn't interrupt my sleep at all on my arm. It kind of hurt at first immediately after I applied it. I guess my arm just wasn't used to an extremity like that. It's not incredibly heavy, but I can definitely always tell it's there. Plus, it will be heavier when it actually has insulin in it. I haven't showered yet or worked out since I attached it, but so far the adhesive is working really well. Nick has decided it's my on-off switch and he's not sure how he feels having a robot for a wife.

At this point I think I'm leaning towards the OneTouch. I've read several comparisons and reviews and lots of marketing material. I'll still be doing more research between now and my follow-up visit to the endo in two weeks. I know that two weeks from now I'll be so ready to stop the four shots a day and just hook myself up to my new artificial pancreas.