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Tuesday, March 8, 2016

A Discourse on Diabetes Technology

Hi there! Still here, still have diabetes :)

Today I am talking about diabetes technology. In today’s diabetes world this can mean many things – blood glucose meters, insulin pumps which can deliver very tiny and precise amounts of insulin (some of which are integrated with continuous glucose monitors, automatic insulin suspension and other safety features, etc.), continuous glucose monitors (CGMs), which deliver (*almost) real-time blood glucose results to a receiver or even your cell phone (by measuring interstitial glucose and correlating that to BG values via calibration with a meter), a multitude of sharing features that allows PWDs and their loved ones to have more peace of mind, and of course, the several ongoing AP (“artificial pancreas”) projects (definitely a misnomer), which aim to integrate CGMs with pumps (either insulin-only or a combination of insulin and glucagon), with the end goal of automatic delivery based on the individual inputs in order to keep BG as close to normal as possible at all times (Whew! Hopefully I covered most of that without too many mistakes or omissions :)

I catch myself often thinking about the “Diabetes Dark Ages” – check out Kelly Kunik’s blog for example - - to learn more about the “Diabetes Dark Ages" – the times of testing your urine (qualitatively) – a very drawn out process, guillotine-type lancets, enormous (and slow) blood glucose meters requiring a “hanging drop of blood”, backpack-sized insulin pumps, and needle sterilization via boiling, etc. Wow – what a pain in the ass! That’s when I remind myself how lucky I am to be living in the 21st century, and currently have a job with health insurance that will cover 80% of all my supplies with a minimum deductible and a max out-of-pocket of only $2k annually. I am thankful to have a good plan through the university I work at this time; over the last couple of years of graduate school, I was much more broke, had crappier health insurance, and although I did manage (with my mom’s help – thanks mom!) to get my hands on the original Dexcom 7+ CGM system, I couldn’t really afford the sensors on a regular basis (shout-out to the #doc folks who sent me their expired ones!)

Although I never tried one, I never felt like an insulin pump would be a good choice for me, personally (that is not to say I would never try one). The reason I feel this way is a combination of the troubleshooting that comes with kinked pump cannulas, occlusion sites, scar tissue, delivery failures (for various reasons, which unfortunately can be very dangerous, as all insulin delivery – basal and bolus occurs via the site, so if anything fails, the threat of DKA becomes very real very fast), battery issues, and a cohort of other potential problems that I have read about on many pumpers’ blogs. Couple those potential issues with my vanity  let’s call it self-consciousness (I don’t really want to have a device attached to me at all times – tubing or not - on the beach, during sex, etc.), along with the high financial cost of pumping insulin, and that  pretty much explains why I am not a pumper. Don’t get me wrong – it works out fantastically for so many people, and I can totally see the benefits of pumping, especially for those who have needle phobias, or are very active and benefit from the easiness of basal dose adjustment/ suspension. 

Moving on to CGMs. As I mentioned, I had the original Dexcom 7+ system a few years ago). It was the most profound piece of technology as far as improving my diabetes management. It allowed me to assess my overnight control, providing a safety net (via low BG alarms) to allow me to run tighter BG control, especially overnight, gave me great insight into postprandial BG values, allowing me to better time my meal-time insulin to avoid post-meal BG spikes, and it also acted as a constant accountability buddy, which was very useful to me. This is why I am super-thrilled to be getting hooked up with the Dexcom G4 system this week!!! I am excited for the slim transmitter (at least slimmer than the original G4 transmitter as of 2014), the sleek (not egg-shaped, eye roll emoji) receiver, the increased range of signal, and hopefully better accuracy and sensor life. I should mention there is a G5 on the market as well – I personally chose the G4 for a couple of reasons, such as the slightly smaller transmitter and the longer transmitter life. I can’t wait, and will have to post some pics and graphs once I get everything delivered (hopefully later today)! Here are some pics of the original Dexcom 7+ system (along with its giant egg-shaped receiver – like really – who thought of that!?) from a few years back. But even this original system changed profoundly my approach to diabetes technology and management alike. 

And even though I don’t like a device attached to me – as Kerri Sparling of points out “healthy is sexy” – thanks Kerri ;) That, and (as with an insulin pump or any other kind of Diabetes technology) we have a choice! We are lucky to have a choice to remove it whenever we want, go back to the more old-school ways of management – we can chose to do what works for us and when and that is awesome! I dream of a world where every PWD across the globe has easy access to insulin and BG monitoring supplies, and I recognize just how fortunate I am. 

Now, I promise not to be a stranger as much as I have been. I miss this place, because it’s like a break from work (while I am at work currently, hehe). Also, because I really benefit from writing about diabetes from a mental-health standpoint, and by connecting with all of you! In addition to writing about diabetes and technology, I soon hope to write more about my low-carbohydrate diet approach, as well as more about travel, stress, and many other things ;) (I am posting it, so I will have to come back soon and write more!)

Peace out. 

<3 MM


  1. I did not use a pump for my first 28 years of having diabetes. Then 14 years ago I spoke to a group of high school students and each of them had a pump. I left the meeting and called my doctor within 2 weeks i had my first one, I simply could not be that far behind. I suspect someday you will get ready and when you do you will love it. Until then,, well its OK, tons of people get along just fine.

    I referred your blog to the TUDaibetes web site for inclusion on our blog page.