Okay, let's just get the scolding over with up front

1

OMG, so much to share, so much I want to say. This is going to require several threads, just to focus the questions I have, and one (this one) to share my joy.

I just started CGMing a week ago last friday, Dexcom G4. That has been an incredible experience and addition to my diabetes management. As type 2 I voluntarily went on insulin therapy 6/2/13 because I wanted to achieve tighter than tight control. I'd been a very bad PWD for about 18-24 months, wound up in the ER almost crashing. After that "come to Jesus" moment, my whole attitude changed.

It was a quick, short journey. Learned about what I could do with a CGM and a pump, and I was back at my endo demanding one.

That was a monday. By that friday, I had the G4 in my hands. A week and a day after that (not even two full weeks from my appointment requesting the technology) my big box o'Omnipod stuff arrived last saturday.

How's that for a quick turnaround?

Anyway, now for the scolding: I went ahead and fired up a pod saturday, without training, without seeing my endo or CDE first. Honestly, I didn't need to. I already knew all my config numbers -- been using them on my own to manage MDI. I've programmed some spreadsheets to handle duration of action based on the metabolic diffusion and clearing models for Humalog. I already know what I'm doing, and my doc all but said that flat out when I saw her to request this stuff.

So, filled the pod, put it on, activated it, programmed my first basal program based on data from a week of dexcom and...

WOOHOO!!!

OH,

MY,

GOD!!!!!

BG has been flatlined between 90 and 110 for the last 48 hours, with two excursions up to 140 after meals. Dawn phenom gone with the adjusting basal.

Now, I know things won't be like this all the time. But I can say that pump technology is such a difference from MDI, it's ridiculous. Every diabetic -- 1, 2, LADA -- should be on a pump. After a mere two days, and understanding the potential for such precise control with this technology, I don't understand why pumps are standard recommended therapy, with MDI a backup plan for people that can't use a pump for some reason, and (for type 2's) oral meds/diet/exercise for those that just won't take insulin.

So, I'm on day 3 with my omnipod, and I'm thrilled beyond words.

The Borgification of Dave is complete; I am now officially a Cyborg, the melding of man and machine, and I ain't going back.

Hmmm... now maybe one of those cool zooming eyes from the Six Million Dollar Man...

2

So happy for you Dave. Me too! I'd cut off my arm rather than give up my pump and CGM! (and I was a hard sell) Life altering for me. Not a picnic, not withoput its hassels and complication.....but so much better.

3

Thanks, Gina!

When I landed in the ER with BG over 500 (no keytones though, go figure), and having been that way for quite a while (personal tragedies and huge hurdles, among them being unemployed and no health insurance), I realized I needed to fix this, or else.

Against the advice (not orders, just advice) of my team, I forced myself down to normal sugars right away. Went through 2 days of awful false hypo at 150 and below as my brain adjusted to the lower sugars.

I can't sing the praises of the Omnipod enough! I don't even know it's there. The G4 on the back of my right upper arm is non-existent as well -- except when I remove a t-shirt... then it catches, and reminds me I need to develop some new habits.

For me, a tech-geeky, numbers guy anyway, the pump is the simplest way to manage diabetes, and get tight, non-diabetic results.

I've already done damage, but don't know how much. Hoping my microalbumin comes down to something acceptable... that's was the out-of-whack metric that has me the most worried. My endo thinks it will get in line with my sugars under control. So much else has -- my BP, for example, went from 180/120 two months ago to 115/78 my last visit -- only change is normal BG now.

And so much else about my health has improved with insulin therapy. Last but not least, as a Type 2 insulin has given me so much more freedom and flexibility in my diet, timing, etc. Shared a bag of Orville Redenbacker's last night with my wife, something I couldn't do before on pills. This time, just picked of the Omnipod PDM, punched in an extended bolus, and never rose over 120. And I ate a pretty good bellyful of popcorn.

YEEHAW!!

4

Dave - Congrats on figuring out a system that works for you. It's interesting to me as a T1 that T2s are finding success using tools (pumps and CGMs) that were in the past often limited to T1s. Kind of makes sense that these tools work well for T2s, too.

Your story confirms to me that when we as diabetics make gains, we travel through a similar process. It often starts with some kind of crisis, and emergency room event, DKA, or a diabetic complication diagnosis. After adjusting emotionally to the crisis, we double down on our efforts to learn about concrete actions that we can take to make our situation better. We're sometimes confronted by others at this point of becoming "obsessive" about our medical situation.

Then we start to integrate some new habits (quantifying food consumption, increasing fnger-sticks, uploading CGMs to data analysis software for example) and our lives gets more complicated in the short-run. But then we start to realize new, concrete, and measurable benefits directly arising from our new habits. The new habits grow easier with time, our confidence increases, we feel a sense of mastery, and our life gets better and easier.

It's like anything really beneficial comes at a short term cost and complication but proves worth it in the end.

This scenario is often followed by increased enthusiasm and a wish to share it with others. But then some people see your description of your breakthrough as too much trouble, effort, or too complicated. While others are inspired by your story and they too embark on a very similar track. And the cycle repeats.

I look forward to reading future chapters about your success in managing well a very difficult disease.

By the way, a 48-hour BG flatline between 90 and 110 is awesome!

5

I'm glad it is working for you, and you're pretty much on the mark with your assessment.

One big deterrent with pumps is that they are very expensive, and cost is a big factor for me. My situation is very similar to yours (recently received Dexcom and Omnipod), and started test driving the Omnipod. I absolutely love the Dexcom, but the Omnipod doesn't work for where I am living (beach community). The PDM is bulky, expensive to replace, and has an exposed port (and strip slot) that just wont fly with the salt water and salt air here. On MDI, I had a pouch in my pocket with everything I needed and with the Omnipod the PDM is relatively large and there are more supplies to carry.

Seems like T2 treatment is bad all around. They often get a combination of oral drugs, and some of those drugs probably kill off some of the remaining beta cells, and then docs will put them on 1-2 types of insulin at the same time. Seems to me that once it gets bad, they should just be on basal/bolus insulin and possibly metformin. Many don't need that much assistance to get their BG numbers to where the establishment feels they should be, and it's hard to get insurance to allow a pump for them. Shortly before my T1 (LADA) diagnosis, I was explaining to my PCP (I also was seeing an endo and am now seeing a new one) that my body produced almost no insulin. I was doing the basal/bolus thing and my body would never self correct a high, but he was trying to convince me to try a combination of oral meds and possibly get off the insulin.

6

Thanks so much for your thoughts and encouragement, Terry. I do realize that the halo of newness will wear off to some degree, but knowing myself, I'm committed totally to this.

Dare I say I'm actually having a bit of fun?

Yes, I'll dare it.

My biggest message to share to everyone out there: Don't be afraid of pumps. After trying to achieve tight control with MDI over the last two months, my appreciation for what a pump can do is that much greater.

A month ago I surprised my wife by taking out on a saturday to buy a new, elegant, totally sexy outfit to then wear out to dinner at Roy's at the Inn at Spanish Bay in Carmel, CA. I'm sure some of you reading have been there. It's a pretty high-end place (I'd bailed on her for a "date" we had scheduled the week earlier 'cause I was exhausted from work, so I had some making up to do).

Anyway, I was in my MDI phase. What a pain to have to run off to the bathroom, inject for dinner. Then do it again an hour later to top off for dessert and an unplanned bit of port.

By contrast, yesterday we were driving together heading for a simple lunch of chicken Tikka Masala (light on the rice for me). She was driving, so I pulled out my pod PDM, kicked of a bolus as we were entering the parking lot, and that was it. Done.

Again, pump + CGM should be standard therapy, covered by insurance, for any diabetic that wants it. It is simply impossible to achieve 5-6 A1c, i.e. non-diabetic BG levels, any other way. Yet, it is possible, and not really that much work and hassle, with the right technology.

Shouldn't diabetics have the same level of care as anyone else? That is, whatever's needed to get as close to "normal" as possible? If you're willing to make proper use of it?

7

Yeah, there seems to be a bias in the healthcare industry that T2 can almost always effectively be managed with diet/exercise/meds.

Well, that's probably true, strictly speaking. But it doesn't account for what I feel is the biggest issue of all: Quality of life.

If one suffers a myriad of hits to their quality of life because of their diabetes treatment, is it really that much better than having complications? On some level it is, of course, but there's room to argue.

What you can eat, how much, when -- those three factors in managing T2 is a much bigger deal than non-diabetics have any understanding for. In the abstract, seems like no big deal.

Then, throw in going to a dinner party. Holiday celebrations. Walking around the Santa Cruz boardwalk, and having a giant pretzel with the kids. And on and on.

All these scenarios present limitation, having to deny oneself, embarassment, explanation to hosts, and on and on and on.

Forever. Never ending.

Insulin frees all diabetics, but in some ways, especially T2s. A pump even more so.

Sorry to hear that your situation presents some real challenges with the Omnipod. I do know that full integration with smartphones is in the works (at Insulet and Dexcom, as well as other manufacturers) -- the glacial pace is caused by the FDA.

When that happens, the amount of gear we have to haul around will be reduced a lot, we will have many choices then for the "reciever" (whatever smartphone works for you), so maybe the pod will be a more usable solution for you.

Thanks for sharing your experience!

8

Can you really ignore all that stuff when you are on the pump? The pump is great and flexible (and sounds like you are doing awesome with it!), but you still need to manage (and weigh/measure) what you eat, refrain from going totally crazy with food, make insulin adjustments for exercise, treat highs and lows ... A pump is more flexible than MDI in many ways, but I still definitely feel like I have diabetes on a daily basis, and it still definitely comes up at meals, during exercise, at work, at social events, and so on in terms of having to explain to others, etc.

9

Glad to read that you're enjoying the flexibility that a pump can give. It's very convenient socially to dose wherever you are. I'd recommend that you monitor your total daily dose. Pumps all keep track of that number.

It's very easy for that number to ramp up over time, you gain a little weight, and you need to increase the basal rate. Next thing you know, it's five years later, you're 30 pounds heavier and none of your dosing tactics work anymore. Just be careful with the convenient dosing; it can cause trouble, too.

10

I'm going through a compressed experience of all of this -- I already experienced the gaining-weight-rather-than-peeing-out-sugar phenomenon after starting MDI. Gained 10 lbs in 2 months. The jeans are a bit... uh... tighter :-)

So, I'm on top of that one now. Had my splurge (the liberation of being in control of BG rather than being controlled by it has it's downside :-))

But your caution is well-taken -- it's so easy now to eat bad -- VERY bad -- because I can just give myself a little o' insulin charge so easily.

11

Oh, yes, of course! You are absolutely right, and the basics of management haven't changed for me. I still count carbs, think about what I eat, and can't just go nuts. Heck, insurance won't cover enough insulin to really act like a PWoD :-)

Part of my enthusiasm is because of the compressed schedule of my experience -- spent two months doing intensive MDI with a glucose meter, transitioning to a CGM and a tubeless pump.

The contrast in QOL was, for me, dramatic. Like I said earlier, the simple freedom of bolusing in the car while driving to lunch with my wife was an enormous difference from MDI, where we would have had to pull over, get all the gear out, and inject. Or wait until we got to our destination, and use the men's room. With the pump, click, press, bada-bing, bada-boom -- done.

The amount of insulin would have been the same either way. However one was so much better in terms of impact on my mood, hassle, etc.