Shapeways 3-D Printed “Brixometer” Dexcom Cover

After having (and wearing out) a couple of silicon sleeves I adapted to cover my Dexcom G4 receiver, I started looking for another, even sturdier option.  Eventually I stumbled across a TuD convo about 3-D printed Dexcom covers.  For under $15 (plus shipping) I now have this form fitting hard plastic cover that was 3-D printed just for me.  (Well, it’s made to order so that’s kind of like it was made for me, right?)

Dexcom Cover

It fits my receiver like a glove, has a slightly textured surface giving it a pretty good grip, and is open on the end to allow easy access to the charging port. (Or, if your sliding charger port cover has fallen off like mine has, you can simply turn this case around and it will fit in the other direction and cover the port when it’s not in use.) Plus it has this nice pattern of holes intended to lighten it and add grip which also give it a nice black and white polka dot look (that I kind of love).

Dexcom cover

As of now, I haven’t had it long enough to comment on durability but I’m feeling pretty good about it so far – the girl who originally posted about it on TuD claims she’s had hers for a few months and it’s holding up well.

To get your own, follow this link to the listing on the Shapeways website.  I bought the “White Strong & Flexible” variety but it can also be purchased in a few other colors and a slightly smoother texture as well.

Shapeways.com

Dexcom Skin, sort of

After stumbling upon this thread at TuDiabetes, I went ahead and purchased an Insignia Pilot silicon case for my new G4 Dex.  The dimensions of each are pretty similar (Dex G4 = 101.6 x 45.72 x 12.7 mm, Insignia = 100.0 x 49.20 x 11.1 mm) and each has a rectangular screen with circular controls.  I held the G4 receiver up to the screen to visually compare, and I figured the circles wouldn’t line up perfectly, but it looked like they’d be pretty damn close.   (I’d also like to note that I ordered this one specifically, and it came with a second case in black, pictured, and a removable belt clip and arm band all for only $4.87!)

Dexcom G4 in Insignia Pilot case

Close, but not good enough!

As you can see in he photo, the alignment is somewhat worse tan I had hoped for.  I lived with it this way for about a week, and then this happened:

Dexcom G$ receiver in modified Insignia Pilot case

Take that!

The result is a somewhat wonky solution that adds traction to the receiver so it stays firmly planted in my jeans pocket, and cushions it a bit when it does manage to fall.  Since the case is made for an entirely different device, and I’ve cropped out a bit of the structure, the receiver is very easily removed, but that doesn’t really bother me.  Plus there’s the added bonus of a conveniently located window perfectly framing the charging port.

Dexcom G4 receiver in Insignia Pilot case

Another happy coincidence.

I’m still hoping Dexcom will get there act together and sell a snugly fitting case designed just for this receiver.  But until then, this may be the perfect solution.

G4 Platinum (aka The One with Terrible Photography)

I have nothing but love for my new G4 Platinum Dexcom system.  Here are a few bulleted points on the matter:

  • Smoother lines.  I’ve seen some discussion in the DOC about the new Dexcom varying from the old.  Personally, I see this as a plus.  If the new behaved exactly like the old I would assume that no improvements had been made.  The pic below shows the same 24 hour period (7+ on my arm, G4 on my thigh) and you do see differences in the graphs.  Looking at these from a purely analytical standpoint I would conclude that they are presenting me with the same data, but the G4 has a better signal to noise ratio yielding a smoother and more accurate graph (I can’t, however, say for certain if this is due to differences in sensor placement if it is real).
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How’s this for a double (almost) no-hitter!

  • The wire is visibly narrower (sorry no picture) which means a more comfortable insertion/wearing experience.
  • I ❤ the color screen (aside from being somewhat more difficult to read in the sun):
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Yay for color screens!

  • Smaller – fits more discretely in my pocket.
  • No silicon cases therefore, more likely to slip out of my pocket.  This is a bit of a problem but will hopefully not result in a receiver in the toilet incident anytime soon.
  • Back to accuracy:  G4 – 140 mg/dL; 7+ – 142 mg/dL; Freestyle – 144 mg/dL (taken about 8 hours post-calibration in the AM).  Can’t complain.

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  • Getting new D-gadgets makes me a better diabetic (at least for a little while)…

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  • Can anyone tell me what the right arrow button is there for??  I’m certain that I have not once had reason to push the left arrow.  This irks me.

Hello, Goodbye

Apidra week from Hell - normally these range bars are short and close(ish) to the green happy-zone. 😦

First a little background as to why I decided to try out Apidra:
I’ve mentioned before that I participated in Joslin’s Why WAIT? program. It was accomplished through a combination of increased exercise, decreased food intake, and the addition of Symlin to my D-regimen. These things combined to cut my total daily dose of insulin in half, and then some. Originally the team had wanted to switch me from Humalog to Apidra because it peaks faster and would theoretically have made blousing with Symlin a bit easier. But, I had 10 vials of Humalog in my fridge, no real job, and switching just wasn’t an option.

Fast forward to last month, about 4 or 5 months post Why WAIT?, to my endo appointment. I approached my endo about switching to Apidra since my humalog supply had dwindled, and, although she wasn’t sure the benefit would be significant, she didn’t see any reason not to try it. So, I walked away with a prescription for a three months supply of Apidra.

After some trouble getting things straightened out with my new online pharmacy, I finally received the Apidra two weeks ago and began using it last week, on Feb 28 at 7pm. And then it began.

Day 1: Hello Apidra. My BG is running high all day; I wake up with a BG of 120, eat nothing and by the time I’m at work an hour later my BG has jumped to over 250. I do correction bolus after correction bolus to no avail and spend the entire work day over 250, even after eating a carb-free salad for lunch. Promptly at 5pm, when I normally head home from work, all of the boluses finally catch up to me and I drop almost instantly to about 55. I correct and make it home with a BG hovering around 100. Dinner is chicken and brown rice. My BG stays flat until bedtime but as soon as I fell asleep, Dex begins to wail. I probably test and correct 5 times overnight and my BG stays flat around 200 all night until an hour or so before dawn when it levels off around 100.

Day 2: Site change in AM. Repeat of day one.

Day 3: After the last 2 days of BG hell , I increase all rates and ratios by about 10% (except the post work/before bed ones) and shorten the IOB time on my pump so I can bolus more aggressively. I also add Symlin to most meals. My BGs level off a bit but they still sit well above my happy zone all day and require frequent corrections that seem to have no effect. I go low overnight.

Day 4: It is like Day 3 never happened and is a repeat of Day 1, again. (Only I have a low-carb, high fiber dinner that send my BG up to over 400!) In the middle of the night I have a low that requires 3 juice boxes and I still wake up the next day with a BG of only 75.

Day 5: Increase all rates again. No change. At this point I realized that I should be monitoring for ketones and luckily find none.

Day 6: Realize that I can’t fix this problem on my own and call Joslin for help. I upload my pump and Dex data from the last week and send it after work. At this point the 5+ days of highs have given me a terrible headache that I can’t quite shake. I officially hate Apidra. However, having a carb-free dinner has allowed me to sleep an entire night without any complaints from Dex. (Although he caught a low before bedtime that I corrected with ice cream perfectly – flat at 100 all night!!)

Day 7: After talking with the nurse educator and experiencing my 8th BG over 400 in less than a week (which is a number I haven’t hit in years!), we decide that I will switch back to Humalog immediately after work today.  Good bye Apidra.  You will not be missed.

So, unless this was some sort of ill-timed, un-related BG surge (which I doubt), everything should be straightened out soon.  And I can’t wait.

However, I now have 5 bottles of Apidra that I don’t know what to do with.  does anyone know of a place to “sell” (It would be great to get some part of the $60 copay back) or donate unopened bottle of insulin?

The Clinical Trial

I spent 52 hours last weekend hooked up to a machine that completely took over control of my diabetes care. The weekend was certainly not without its ups and downs but in the end I am happy to have been a part of the study.

First a little background information.  This study, known as  Integration of Continuous Glucose Monitoring Into a Bi-Hormonal Closed-Loop Artificial Pancreas for Automated Management Of Type 1 Diabetes (CL2)   has two principle investigators; Steve, who oversees the clinical trial and all things medical, and Ed, who oversees all of the pharmico kinetic (no idea if I spelld that right!) and engineering issues.  (Funny side note: When Googling “Steven Russel” for that hyperlink, I came across this person who is definitely not the same Steven Russel as the one leading this study.)  I only met Steve breifly so I don’t know much about him, but Ed developed his passion for diabetes care when his son, now 12, was dx’d at 6 mo.  He is incredibly passionate about his work and was very forthcoming with information.

Ed explained to me a little about the evolution of the project and how their first patients were pigs (diabetic pigs are cute) and after those trials were so successful they began clinical trials with human subjects.   They have ran their experiment many times and with each trial they learn something new and then incorporate what they learned into the next iterations of the study.  For example, many of you know Abby Bayer over  at SUM, and may have read about her experiences with the same trial here (and here).  Because of her, they told me that now they are keeping a closer eye on subjects’ nausea to see to what extent this really is an issue.  They are also exploring to what extent the excessive food intake that they require may have played a role and if they should find some way to scale food intake to body mass or something.  Before he left, he showed me that he could see my graphs on his iPhone in real time and told me that I shouldn’t worry because, as usual, he will keep a close eye on it for the duration of the experiment.

So, I was hooked up to two OmniPods, one with insulin and the other glucagon; 4 CGMs, a Dexcom, a new Guardian (next generation, not yet on the market), and two Navigators, one active and one back up; and an IV that fed my blood to a Glucoscout which provided an accurate BG level with which they could evaluate the various CGM data.  The active Navigator and the pods were connected to a laptop computer that had complete control of my insulin and glucagon dosing.  All the software knows is my weight, the CGM data provided by the Navigator, and if I am about to consume a meal and it then doses either insulin or glucagon accordingly.   It also learns from the past and adjusts all doses according to how your body reacted previously.

I would easily rate their software a 4.5 out of 5.  On day one, I ran sort of high. This was due mainly to the lack of previous data upon which the software could adjust my doses.  For every meal on day two the software did a better job of  keeping my BG in range.

Imagine a world without basal testing or carb counting…

…where I can be blissfully unaware of the carb content of that piece of pizza…

Unfortunately, overall, I’d probably only rate the entire system a 3 out of 5.  The reason this number is so much lower than that I gave the software is because the difference between my blood glucose and the reading provided by the CGMs were just not close enough.  At one point, I received a dose of glucagon when my BG was 180 because the CGM told the machine I was 120.  Another time (actually twice), the CGM stopped providing information at all to the software (which required numerous new Navigators to be applied) at which point the software seemed to resort to a standard basal rate which was too low the first time right after I ate a meal (which led to BG readings in the 300s and trace ketones) and too high in the middle of the night (resulting in juice drinking and almost an end to the study).

Remember how I said that Ed told me that he would be watching my graphs all weekend?  It was totally true – any time the Navigator went off line or the readings differed from the Glucoscout to the Navigator, the phones were ringing constantly because the entire research team was watching from home and wanted to know exactly what was going on.

As much as that fantastical world without basal testing or carb counting sounds great, I wouldn’t leave my diabetes in the care of this machine with only the current CGM technology to power it.

So, 52 hours, 4 IVs, 6 CGMs, 6 pods, and 480-720 grams of carbs later, I survived the clinical trial and am really no worse for the wear.  I got to experience a bit of what diabetes management might be like in the future and I like it!

Image source: http://www.diabeteshealth.com/cartoons/type-1/477.html