I currently use the 670G with the Guardian 3 CGM. Last year my endocrinologist recommended I try the 670G and I had no issues getting approval, and I started using the system in March of 2018. My A1C is worse than it has ever been. The 670G target BG is programmed to for 120mg/dL and unchangeable. My target BG has always been 90mg/dL.
But I've had too many issues with failed sensors over the last year. I have called into the support line over two dozen times since getting the 607G. I was losing my patience, and each call into the support center ended with a " ... we will send you a replacement sensor". The support reps responses made it seem that the problem was me, not the product.
No matter how carefully I insert and tape down a sensor, The sensor reading becomes unstable when I exercise. Medtronic reps told me directly, “The sensor can become unstable during vigorous exercise.” It was recommended that when this happens, I should replace the sensor. I exercise every day. What am I supposed to do?
Eventually, after numerous calls over two months last fall, I was given a link to request a new transmitter with updated firmware. That was several weeks ago, and I have not heard anything from Medtronic.
I don’t care anymore. The system is unusable to me. If I can’t exercise safely or go hiking with a CGMS, then it serves no purpose.
This week I had a long chat with my endocrinologist. She stated her other patients were doing well on the 67G and G3. They had improved outcomes, but these are patients who were never as tightly controlled as I was. She called Medtronic on my behalf. A Medtronic diabetes educator called me, and we spoke. She admitted that my A1C would be higher with the 670G system in auto-mode and recommended disabling auto-mode. So that is what I will do.
I may talk to my endo about going back to Dexcom. The G6 seems like a fantastic bit of kit.
This post is about a number of things that have been on my mind for a while.
Photography
During the 2017 end of year holidays, I dropped and damaged the mirror box of my Nikon D5100 baby DSLR. It was not a new camera when I bought it on eBay (circa 2012) but it worked flawlessly for the years I have owned it. Surely had I not dropped it, it would have yielded at least another 5 years of service. I was quite upset when I discovered was damaged but excite that the lens that was attached was in good shape. I was also excited at the prospect of buying a new camera. The D5100 was released in April 2011 and in the intervening years, newer, and more capable cameras had been introduced by Nikon, Sony, Fuji, Olympus and Canon. Buying a new camera, however, presented a new challenge. Which camera to choose?
Kingston Mill
Canon EOS 5D Mark III + Canon EF 70-200mm f/2.8L IS II USM @ 70mm ISO 100 1/320s ƒ/4
There is a lot of buzz around mirrorless interchangeable lens cameras (MILC). A new term is needed to describe these types of cameras. The term mirrorless camera is as silly as the term horseless carriage. I suggest the term digitial viewfinder camera(DVC) or digial interchangeable lens viewfinder(DILV) or electronic viewfinder(EV). Whatever you all it though, the news style of interchangeable lens camera seems to be popular with many photographers.
At one time or the other over the last two to three years I have rented Olympus, Sony, Fuji and Panasonic interchangeable lens cameras. They all have pros and cons with the newer iterations of each camera improving and reducing the problem areas.
I must look like a wet mangy dog without my camera because my wife's best friend offered to let me use her father's1used camera and lens; a Canon EOS 5D Mk II with Canon EF 70-200 USM IL f/2.8. The 5D Mk II is a full-frame DSLR with "pro" level features. The EF 70-200 mm lens is worth more than all my existing lenses combined. I've never used Canon camera's and lenses and I wasn't sure what to do with this kit as is. Last week, after learning from a work colleague that any EF lens will work with the EOS 5D MK II, I started looking on eBay for used 35mm and 50mm EF lenses. In my mind, it was worth it to get a used lens for less than $100. I was tired of shooting photos of the birds in the backyard. However, I didn't need to.
Fisherman
I remembered that my Dad has given me his Canon Rebel film camera a few years ago. I knew it was somewhere in the basement. I took a few weeks but I finally found it. It has a Canon EF 28-80mm f/3.5-5.6 lens. It's compatible with the 5D Mk III. I took the camera and lens on a recent road trip to Michigan and Ohio. I downloaded a few of the photos and noticed that the quality wasn't what I expected. The images all seem "hazy". I assumed it was due to poor skill on my part -- shooting images with the light in the background. But I noticed that photos taken indoors with front lightning had the same issue. I examined the lens and discovered that some semi-transparent "goo" on the inside of the lens.
If I continue to use this lens, I will need to use the Adobe Lightroom "dehaze" tool for every captured image.
I found some inexpensive Nikon to Canon lens adapters on Amazon. I could use my existing Nikon lenses. The caveat is that the adapters do not allow the use of auto-focus and TTL metering. I promise I would not replace my Nikon until after my 2017 taxes are filed. I can't wait. Perhaps I'll get a deal on a Nikon D500.
I've also struggled with impostor syndrome. I look at the excellent work by an artist like Olaf and. I compare my work to theirs; which is a mistake. Olaf and have talent and years of experience. I'm just an amateur who photographs mostly on the weekend. The comparison leaves me feeling inadequate. I put the camera down and my skills atrophy. Why am I doing this?
Old Route 27
Graves Disease
Over 12 years ago, I was diagnosed with Type 1 diabetes. After diagnosis, I started seeing a specialist, an endocrinologist, about every three months. On these regular visits, we discuss insulin regimen, diet, exercise and the results of my lab tests. The lab results have lots of information that is interesting and useful to an endocrinologist but I only paid attention to the cholesterol and A1C values. But my endo looks at all of it.
One of the things she was testing, was my thyroid function, which until recently was normal. And then it wasn't. She tested my thyroid function because people with other immune system diseases, such as type 1 diabetes, have an increased risk of hyperthyroidism. And the onset happened just as rapidly as it did for my Type 1 diabetes. After a battery of test over a few weeks, my endocrinologist confirmed a diagnosis of Grave's Disease which the American Thyroid Association describes thusly:
Graves’ disease is an autoimmune disease that leads to a generalized overactivity of the entire thyroid gland (hyperthyroidism). It is the most common cause of hyperthyroidism in the United States. It is named after Robert Graves, an Irish physician, who described this form of hyperthyroidism about 150 years ago. It is 7-8 times more common in women than men.
Graves’ disease is triggered by a process in the body’s immune system, which normally protects us from foreign invaders such as bacteria and viruses. The immune system destroys foreign invaders with substances called antibodies produced by blood cells known as lymphocytes. Sometimes the immune system can be tricked into making antibodies that cross-react with proteins on our own cells. In many cases, these antibodies can cause the destruction of those cells. In Graves’ disease, these antibodies (called the thyrotropin receptor antibodies (TRAb) or thyroid stimulating immunoglobulins (TSI) do the opposite – they cause the cells to work overtime. The antibodies in Graves’ disease bind to receptors on the surface of thyroid cells and stimulate those cells to overproduce and release thyroid hormones. This results in an overactive thyroid (hyperthyroidism).
Kingston Mill
Looking back over the last few months, I know I felt the symptoms of the disease, even though I did know how to interpret them.
I was anxious and irritable and quite emotional. Anger. And sadness. My hands are shaking slightly and it is harder to use a computer -- either a keyboard or touchscreen. I am sensitive to heat and it feels like I am sweating into my socks. I feel tired while simultaneously feeling energetic (heart palpitations) and falling asleep was is challenging. I lost seven pounds.
So now you know. I now have two autoimmune diseases. My endo gave me options for treatment -- pills, surgery, radiation therapy. I opted for the pills. I am hoping the pills work.
I'll also find out from her what the other results on my lab test mean. Am I at risk for another autoimmune disease?
Work
Work has been stressful since a management change last year. As a consultant, I had worked harmoniously with the last two managers but over the last year, I had felt the relationship with the new manager was straining. It was also causing me considerable stress. On Monday I had a panic attack while at the office. I came home early.
My wife reassured me that she was onboard with me leaving. The toxic environment created by this person was affecting my mental and physical health.
Lake Carnegie
I had started looking for new opportunities elsewhere but this week my work for the client came to an abrupt end. I was told that my services were no longer needed. I didn’t say a word. I didn’t ask why. I simply said “ok”, packed up my day bag, handed in my laptop and pass, and left.
Now I have time to focus on finding my next gig or my next job. I’ve spoken to a few recruiters and also reached out to a few colleagues and friends. Next week I hope to be busy with interviews and hope I will have a few offers buy the end of April.
Writing
As a blogger, it’s easy to fall into the trap of thinking everything I write about is already known by everyone, or that my audience on Island in the Net has seen everything I’ve ever published. It’s good to remember that every day, someone might be part of the few to learn something new-to-them, even if I've written about it previously.
I have a backlog of about 116 articles in draft mode. The majority of these are technical articles about photography, web development, and the IndieWeb. I want to set aside time to work on these. Perhaps some will be long form, but I suspect most will be short.
Diabetes
My diabetes management is fairly good. I usually manage to keep my A1C within the recommended range. But managing diabetes is not without challenges. Because, I often get hypoglycemic when I go hiking, I don't exercise as much as I may need for optimal health. The fear of the hypoglycemia keeps me sitting at the computer. But that may soon change. A new type of insulin pump is on the market and I have one of the first models, the Medtronic 670G. It's a closed loop system. Readings from a CGMS are relayed back to the insulin pump which can adjust insulin delivery to suit the need. On Tuesday I was trained in how to setup and use the CGMS and 670G. There is a little bit of a learning curve. I had my ACCU-Chek insulin pump and Dexcom CGMS for over four years. I had mastered the technology. I'll have to learn anew.
I am beginning to feel that an insulin pump isn't right for me. It's been almost two weeks since I started using my insulin pump and I still have no clue if my basal and bolus rates are correct.
I have worked with a certified diabetes educator (CDE) from Roche to get my basal rate set. The first few days were challenging. I got a lot of hypos, requiring lots of treatment with smarties. The CDE considered the data unreliable since treating hypoglycemia doesn't allow us to see how low I would have gone with the rate and how much we should scale back. Of course I can't allow my BG go too low since the complications are immediate. I started using the pump in the middle of the week1 and I had a family event on the weekend2 so doing the "skip-a-meal" test wasn't something I thought I could do.
We tried for the next week but the results were mixed. It was also a very busy week3 at work. I had a number of back to back meetings all week but I tried to eat pretty much the same thing every day. I still had a lot of hypoglycemia but we thought we had made progress on the midday basal rate. We just needed to work out the basal rate for breakfast and dinner.
We modified a number of things including insulin/carb ratios and basal rates for different times of the day and I had fewer hypos that week. But I now had more hyperglycemia.
The CDE recommended I add some fibre to my fruit/vegetable blends. She thought the blends had too much sugar and not enough fibre. She also recommended drinking milk to add a fat to help slow digestion. I don't drink milk. I don't like it and I don't feel well afterwards. I was also advised to have my morning coffee later in the day instead of at breakfast. Somehow coffee might be raising my blood sugar in the morning.
On Roche's site one of the benefits of using a pump is stated as thus:
Plan your life, not your insulin scheduleAccu-Chek
The more I modified my diet and lifestyle to make the numbers works the more I became disenchanted with the pump. My normal breakfast is a blend of spinach, flax or chia seed, and berries or other fruits in a Vitamix. Total number of carbohydrates is about 17-20g. The flax, spinach and chia seed add healthy amounts of fibre. I don't eat eggs, toast and bacon for breakfast. I'd probably throw up if I did.
My lunch is usually a sandwich; a few slices of deli meat, low-fat cheese, lettuce, some may or mustard, between two slices of multi-grain bread. About 40g or carbohydrates. My wife insists on cooking dinner but I will occasionally eat a Trader Joe's packaged meal. A cooked meal may include one serving of brown rice or quinoa, vegetables, and organic fish or organic chicken. The only other meat we eat is grass-fed organic meat but we do that occasionally. We rarely eat out.
Does that sound like the a diet that needs to be modified? Do I really need to chuck my Vitamix and starting eating shit for breakfast? Do I really need to skip a meal and pop and aspirin for the resulting headache while listening to my stomach growl?
Does it make sense that went to bed with a BG of 101 on Saturday night and woke up with a BG of 140? Does it make sense that I went to bed Sunday night (last night) with a BG of 140 and woke up with a BG of 65 on Monday? Does it make sense that I ate the same things for breakfast on Sunday and Monday (this morning) and yet my 2HR post-prandial BG on Sunday was 140 and now (Monday) my BG is headed below 80?
Accurate carb counting is critical for getting the most from your pump.Excerpt From: John Walsh, PA & Ruth Roberts, MA. “Pumping Insulin.
The only way I know of to get accurate carb counts is to eat prepackaged processed foods. Surely this can't be a good thing! I am beginning to think the entire diabetes medical industry is full of shit. Am I supposed to stop eating home made meals unless I weigh and measure every ingredient and then compute nutritional information? Can I now only eat home cooked meals that come from a recipe book that includes nutritional information? Do I only eat at fast food and chain restaurants that have nutritional information available? Are all the local restaurants verboten? Explain to me how a pump fits in with my existing lifestyle or do I need a new one?
I feel the way I felt when I was just diagnosed. I feel like I don't know my body. I don't feel like I have control of my diabetes. I spend more time thinking about my diabetes with the pump then I did when I was on multiple daily injections. I find myself constantly checking the CGMS to see if I am headed for a hypo so that I can set a temporary basal. I find myself testing more often because I started to doubt the CGMS. I feel like I spend more time planning my insulin schedule than my life.
We have been unable to get anything sorted out in the almost two weeks since I started using this pump. Nothing makes sense to me anymore. I have lost control and that is pissing me off. I am disappointed. I am back where I was eight years ago when I was first diagnosed.
But, not wanting to be accused of not given pumping a chance I have decided to give it one more week before I call it quits on the insulin pump. I have set the range on my CGMS to between 80 and 200 so that I won't get "buzzed' by my CGMS in the middle of meetings and the middle of the night. Today and tomorrow, I will eat the same EXACT thing for ALL my meals. On Wednesday, I will skip breakfast. On Thursday I will skip lunch. And on Friday I will skip dinner. Hopefully I won't throw up from eating the same thing for every meal. Hopefully the hunger headaches won't affect my work. Hopefully I can get some restful sleep.
If we don't have a reliable set of observations to work with and we can't get my life back, then I am done with pumping. I will send this unit back to Roche. I will not change my diet and lifestyle to suit this device. It seems to me that is the antithesis of the supposed benefits.
I've read that a lot of people do well on the pump but I think and insulin pump may not be the best thing for me.
My endo wanted to be present during the procedure and was booked for weekends. ↩
A pizza party for my nephew but I expected his Dad and I would also want beer. ↩
I am consulting on project with a very tight spring deadline. ↩
