Health Canada Approves DexCom G4

DexCom announced yesterday at their May 1, 2013 Earnings Conference Call that...

"On the international front, we are pleased to report that we have received approval from Health Canada to begin marketing the G4 system in Canada. Our initial approval is for adults only. However, we expect to file supplements seeking pediatric approval later this quarter. Our distributor in Canada expects to commence a limited launch at the beginning of Q3 with the full launch commencing before the end of Q3"

Congratulations to my Canadian friends who have been patiently waiting to use DexCom's G4 system!

This Picture Makes Me Smile

Do you see Arden in the middle of the purple glowing smoke, the one wearing the hat. Arden danced the night away on Saturday during her first Bar Mitzvah without a care in the world. I just wanted to take a second to tell everyone how grateful my family is for the technology that makes moments like this better. Without Arden's DexCom G4 I would have interrupted her fun countless times during the evening. Each time taking her from the moment and drawing attention to her diabetes. Instead, we were able to monitor her post meal BGs from across the room and when she did require a bolus of insulin, I never took her OmniPod PDM out of my pocket. 

Wireless. Tubleless. Goodness.

Knowing that Arden was safe, carefree and completely unencumbered by diabetes while she danced is a feeling that may be lost on other parents, but I think that every parent of a child with type I will look at his photo and smile along with me. As a father, I found this moment to be completely joyous - nothing beats seeing my kids live without limits.

Have a great week!

Scott

The Not So Great but VERY Powerful Bolus

Arden's CGM vibrated on my leg. Earlier during the previews I asked Arden to give me her G4 so that I could monitor her BGs while we watched 'Oz The Great and Powerful'. The vibrations that her CGM sent through me were too intense to ignore and moments later I was greeted rudely by the message on it's small glowing screen.

Arden's CGM indicated that her BG was 94 and the number's accompanying arrow was pointing straight down. You can see on the chart below that's not good news.

From the DexCom G4 Users Guide

Prior to the movie we stopped for a light meal, Arden had a salad and one baked potato skin. I pre-bolsed for twenty carbs, ten minutes prior to the waiter arriving with our food, she ate as I expected. A little over an hour later we settled into our theater seats (about thirty minutes before the movie was scheduled to begin). Arden was holding a box of Bunch-a-Crunch, a small popcorn and she was talking about sharing a few gummy candies with her friend who was joining us. I pre-bolused for forty carbs at this time. We donned our 3-D glassed and the movie began.

95, one arrow straight down

A CGM reading of 95 doesn't phase me, and one arrow down doesn't really cause me to become alarmed anymore, "Just missed with the bolus", I thought. Then I looked at the time on the OmniPod PDM and became a bit more concerned. This was all happening only one hour into the movie, I had more than "just missed" - I significantly over estimated how much Arden was going to eat. I shook the candy box, reached into the popcorn bag and discovered that she really hadn't eaten any of the treats that we initially believed she would. I reached into the gummy candies, put five in her hand and whispered, "Eat these please, your CGM says 95, one arrow down - I think I gave you too much insulin".

Arden ate the candy quickly but three more alarms were already shaking my leg

Now her CGM was reporting a BG of 84 with one arrow down, seconds later it was 76 and then the arrows doubled. 76, two arrows down. Arden's BG was running away from me. I had already opened the juice box by the time the double arrows hit, Arden knocked it back like a shot as I tested to autenticate the numbers on her CGM. Her BG was 56 on the meter and the arrows were staring back at me as if they were awaiting an answer to the question, "What are you going to do Scott?".

I recounted the carbs in my head based on what I now knew she had eaten and then added the new carbs that she just wolfed down to that total. I was okay, I knew that the numbers matched. I told myself, "Just wait, don't over treat" but no sooner than I was able to talk myself into that response...

BEEP, BEEP, BEEP, BEEP - "LOW, two arrows down"

I could feel my adrenaline surge when the beeps angrily blared out. I started looking around to see which way out of the aisle was less blocked, thought about where the snack stands were located and considered sending our son Cole for a cup of regular Coke. Then I looked at Arden, she was sitting next to her friend who came along with us for the movie and I just didn't want her to have to rush around like the world was coming to an end in front of her pal. So I quietly slipped Arden a glucose tab (We never use glucose tabs), I asked her to chew it up quickly and swish the powder around in her mouth.

She did so dutifully, then leaned over to me and whispered in my ear, "am I going to be okay?"

Those words broke my heart and brought a tear to my eye but I answered without hesitation, "absolutely, Daddy has it all under control, go back to watching the movie", but I wasn't sure. The CGM still said "Low", though now it was reporting only one arrow down - so I tested again and this time Arden was 68. I could breath again, she was going to be fine.

I asked Arden how she felt and she responded, "A little dizzy but I'm okay". I told her that we caught the fall and that she should go back to watching the movie. Her friend never saw a thing, I did however miss the flying baboons... I heard they were fierce though, Arden told me later in the car. She knew because she never had to take her eyes off of the screen, mission accomplished.

The DexCom CGM is an indispensable tool in our day with type I diabetes. I genuinely never imagined that Arden wouldn't eat the amount of food that we bolused for. This was a complete anomaly, movie theater food always needs a strong bolus, this never happens - until it did. CGM technology is the best. Who knows how this all goes with out the Dex, maybe Arden would have gotten dizzy and told me that she didn't feel well, maybe the movie would have held her attention to the point that she didn't notice. I'm thankful that we didn't have to find out.

I gave her way too much insulin, that happens. The DexCom CGM makes that eventuality feel less scary.

Update on 2013-03-20 15:25 by Scott Benner

My new book, "Life Is Short, Laundry Is Eternal' is available now - Amazon/Kindle - Barnes&Noble/Nook

Be Bold and Pre-Bolus Insulin

This story begins in 2006 just moments after I asked Arden's nurse practitioner if she was "nuts".

NP: <blank stare>

Me: <incredulous gaze>

Only moments before our staring contest began Arden's NP became the first person to suggest that I give Arden her mealtime insulin before she started to eat. I can't be sure if she referred to the practice as pre-bolusing, probably not as we were MDI, but she definitely wanted me to inject before Arden ate.

"Are you nuts?"

I responded emphatically that I could never give Arden insulin before she ate. Arden was two years old and there was no way to be certain of how much food that she would finish. The NP repeated her very reasonable request but I could not wrap my head around this new idea. Pre-Bolusing, bah, Arden would be safer if I left her alone at the mall with money pinned to her shirt.

Original art by Mike Lawson - Check out Mike's YouTube page by clicking on the image

I was 100% correct on that day. There was absolutely no way to be sure of Arden's appetite. However the inability to guess how much she would eat wasn't the only reason I didn't want to inject before meals. Arden weighed maybe nineteen pounds at the time and Novolog had a way of peaking intensely in her body. She had already experienced a seizure from an insulin miscalculation that I made. That mistakes lesson was still very fresh in my mind and with that bad memory still looming over me, I just couldn't bring myself to administer insulin that wasn't already covered by food or a high BG.

Of course everything that the NP said made total sense. I wanted to give Arden's insulin a head start, I dreamt of a moment when her food would begin to expel it's carbohydrates just as the insulin was pulling her BG lower. I could picture that perfect image in my mind, a tug-of-war with food on one side and insulin on the other. Both combatants pulling furiously without once moving the rope that is Arden's blood glucose value - the dream of a steady mealtime BG. I wanted very much for that to be our reality and so I promised myself that I would make the adjustment when the time was right.

Fear and poor timing stopped me from taking the NP's advice all those years ago. Eventually the day came when I found my footing with the idea and gave up on being scared... that's the day Arden's A1c began to decrease.

We haven't looked back.

The beginning of our trip down the road to pre-bolus freedom was littered with pot holes. The first bump took some time to traverse, we first had to wait until Arden was old enough to give thoughtful consideration to her hunger. After that hurdle was cleared we took the first step, bolusing ten minutes before a meal. Those next ten minutes were the most tense of my day, I would test and worry so much after the bolus that I barely had time to finish cooking. Initial results were less than stunning so I moved the pre-bolus to fifteen minutes before a meal. The extra five minutes increased the impact of the insulin and lessened Arden's post meal spikes, but I still wasn't seeing a huge return on our efforts. I wanted to take the process to another level but I couldn't, in good conscience, give Arden insulin farther from the beginning of her meal. If only I could see the insulin work, I needed a crystal ball...

... or a DexCom CGM

Arden's CGM turned pre-bolusing into the most valuable weapon in our arsenal. It's one thing to have a good idea of how long it takes insulin to begin working in the body. But when you are able to not only witness the movement of the BG, but also the speed with which your glucose level is rising or falling... it's the difference between rumor and fact... between guessing and knowing with reasonable certainty. The day that my eyes were opened to the benefits of wearing a CGM, that was the day that everything changed.

Arden was 149 before dinner last week. I bolused for the elevated BG and pre-bolused for 50 carbs, it was a significant amount of insulin for her. Before DexCom I would have panicked and served the food in less then ten minutes. Now I take my time finishing dinner while Arden and Cole do their homework and leisurely prepare their plates as I wait for the CGM to tell me when to serve.

I put dinner on the table when the arrow on Arden's DexCom G4 turned south, waiting until her BG was below 110. The amount of time between Arden's bolus and her BG decline can vary most days depending on a number of factors. Glucose monitoring grants the flexibility to wait, providing a level playing field for the insulin and those scrappy carbs to wage their battle on.

At least now it's a fair fight.

Don't forget what the disclaimer says... Always consult your doctor before making changes to your health care. I am not a doctor.

More about the art: The art work displayed at the top of this post is an original piece from Mr. Mike Lawson. Mike is a tireless advocate for people with diabetes, a friend and extremely talented artist. You can find him working at TUdiabetes, on Twitter and through his fantastic YouTube channel.

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Opsite Flexifix

For the first time since Arden began wearing a CGM we are using a third party product to aid with adhesion. Back in December I realized that the adhesive on the new DexCom G4 sensors wasn't as resilient as it was on the prior version of the device. I tried for a few weeks to be sure that we weren't just having a bit of bad luck, but after a few attempts my suspicions were validated. As others started to experience the same lack of longevity the Internet became littered with folks saying that the new DexCom G4 adhiesive just doesn't stick like it did with the 7+.

I knew instantly that I wanted needed to add a third party product into the mix and I began to search online for options. All of my research led me to want to try Opsite Flexifix first so I ordered a roll on Amazon and waited for the UPS driver to arrive. 

I later found a post on the D-Mom Blog that explains, step-by-step, how Leighann prepares her daughter's Flexifix to work in conjunction with a CGM sensor. I co-opted Leighann's plan for how she cuts the center hole and made one small change. Instead of a significant overlap, I cut the Flexifix just slightly larger than the DexCom's original adhesive (image below).

Tomorrow will the twenty first day since the sensor above was applied.

Opsite Flexifix, write it down.  

Update on 2013-02-07 15:18 by Scott Benner

Here it is Shelley.