Five Days as a Pre-Borg (Diabetes Related)
Last Thursday, I went in to get set up for a five-day run with a continuous glucose monitor (CGM).
Quick overview – with type one diabetes, the pancreas up and quits producing insulin, because it’s a LAZY SLACKER! Therefore, I take insulin via an insulin pump, which delivers a baseline dose throughout the day, and allows me to program additional insulin when I eat. I check my blood sugar about six times a day to help me keep it within a relatively healthy range.
The CGM is a device that automatically checks your blood sugar every five minutes. It automatically sounds an alert if your sugar goes too high or too low. (Sadly, it can’t be programmed to do the red alert klaxon from Star Trek, but some day…)
It works by measuring the interstitial fluid, as opposed to the blood, so the measurements aren’t quite as precise as the ones from my glucose meter. But it does a great job of showing trends (whether your blood sugar is climbing or falling or just chilling and hanging out). It also produces a graph to let you see what your blood sugar is doing over time.
I was hooked up with a Dexcom CGM, which involves a tiny flexible needle that goes into the side of the belly and is hooked up to what may or may not be a T-800 chip from Cyberdyne Systems. This made me a little nervous, since I’ve already got the catheter from my insulin pump stuck to one side of my belly, and the CGM is a little bulkier, as you can see here.
This was at the end of my five-day run, and you can see that the adhesive around the edges was starting to give up.
Along with the Skynet Chip, there’s a handheld receiver that needs to be kept within about five feet. It records the readings every five minutes, and also lets you enter data like how much you’ve eaten or how much insulin you might have taken.
The whole thing takes two hours to boot up — they said it takes time to calibrate, but I think that chip might be running Windows ME — and then it basically runs on its own. It does ask you to input you glucose meter readings from time to time to make sure its readings are matched up to yours.
There are a few downsides (in addition to being one step closer to becoming a Cylon). The receiver buttons are annoyingly loud. Given how I tend to obsess over data, I spent too much time poring over the graphs, and probably overthought things a bit. The biggest challenge was because food and insulin don’t have an instant, real-time effect on blood sugar. So if my sugar was dropping, I’d grab a snack, but the readings would continue to drop for at least another 10-15 minutes … which meant I tended to overcompensate. Likewise with taking insulin when my sugar was too high.
Overall though, I liked it. I really like the safety of that alarm, which would help me avoid extreme highs and lows. I already picked up on one way I need to adjust my insulin boluses at meals. I’d be able to do a better job of fine tuning my insulin pump’s baseline dose.
Will I get one of my own? I don’t know yet. Like most of the toys keeping me alive, this one isn’t cheap. A friend said she was looking at paying about a hundred a month for hers, with insurance. And one of the things the doctor and insurance company will probably look at is whether or not I need a CGM. It might help me better control my diabetes, but if my diabetes is already under good enough control, is it worth it?
But I’ll sort through all of that later. For now, I’m just amazed at how far the technology has come. 30+ years ago, you’d pee on a strip, compare the color to a chart on the canister, and that would tell you very, very roughly what your blood sugar had been about four hours ago. Whereas I’ve spent five days walking around with one computer giving me my insulin while a second, wireless computer provides near-realtime information on my blood chemistry.
It’s not a bionic pancreas, but it’s still pretty cool.
April 9, 2014 @ 9:40 am
Out of curiosity, do you need a prescription for the first step to being a Cyberman? I mean, I’m trying to talk my endocrinologist into giving me a pump, but I’d also love to get better readings on my BGLs, since I have issues checking when not at home.
Jim C. Hines
April 9, 2014 @ 9:43 am
James – The insulin pump requires a prescription. The five-day test run on the CGM did not. I basically borrowed the hospital’s CGM for a week. However, if I decide I want one of my own, then I believe I’d need a prescription for the CGM and the supplies to go with it.
April 9, 2014 @ 11:09 am
I am still baffled that there are not less-invasive methods available yet. The one who creates the first non-invasive CGM would kick himself into the super-rich league.
I have several cases of diabetes (type 1) among close friends and relatives. Especially as people get older, the control slips more and more. Getting this reliably automated would be a real life enhancer.
April 9, 2014 @ 1:03 pm
About 2-3 years ago, there was a research who managed to come up with a biolumencent device that sat underneath the skin. It would light up a number of dots based on the level whenever you pressed your finger against your elbow. It was kind of cool, but sadly it never got outside of the “isn’t this neat phase”.
But, hopefully your Cylon leanings can be fulfilled properly. I know that my dad got so obsessed with his heart monitor that he had to decode the format so he could “graph it right”. Seeing the joy he got out of it, I can see where it would be addictive.
April 9, 2014 @ 4:40 pm
He’s the Six Million Dollar Writer! (slo-mo sounds)
Well, at $1200/year, you would have to live millennia to achieve $6M, but it’s worth a shot, right?
The pee on a strip was still pretty common 20 years ago, that’s what my dad used.
Alicia Butcher Ehrhardt
April 9, 2014 @ 6:07 pm
If it saves you one diabetic coma or a trip to the ER or a seizure or any of the effects of unregulated blood sugar, it’s probably worth it to the medical insurance folks.
That will be the kicker: are you having trouble living without it? Because one diabetic coma, etc., is too many – and can do very expensive damage – damage the insurance company will end up footing the bill for.
It’s not like you’re trying to scam them – proper economic arguments would be better.
And if not now, then when the things get better and easier. I still think a laser pulse through a thin area – such as the webbing between fingers – with a receiver on the other side, should be able to produce instant readings with NO holes poked in the recipient.
Jim C. Hines
April 9, 2014 @ 6:26 pm
That would be awesome! “Hey look, kids! My belly lights up in binary code!”
Jim C. Hines
April 9, 2014 @ 6:28 pm
They’ve been working on a few options along those lines. There was a laser-lancet that blasted a tiny hole in the skin instead of using a blade, but you were still bleeding. And I read about another path where they were trying to take a pinch of skin and scan it with infrared to measure the blood sugar. (I’m sure I’m getting some of the details wrong here.) Haven’t heard of either technologies getting any further, though.
April 11, 2014 @ 11:13 am
Do you worry at all about either pump getting bumped out of place while you’re sleeping or practicing martial arts?
Jim C. Hines
April 11, 2014 @ 11:53 am
Sleeping has never been an issue. I just have to make sure my pajamas all have pockets. But I’ve busted two pump cases (not the pump itself, thankfully) during karate when my sleeve catches the case and snaps the plastic. I bought a different kind of case that seems to be working better. I also have to tell any workout partners where my infusion site is so they can (hopefully) avoid hitting me in that particular spot.
April 14, 2014 @ 2:42 pm
When my son was about two, he had a 14-day trial with a CGM that was considerably smaller than yours. It didn’t have a reader; it stored the data, and at the end of the trial the sales rep who was working with his endocrinologist plugged it into a dongle-looking thing (similar to the one I’ve got for my FitBit) and zap! All the data was uploaded. Like you, we had to also continue to take regular blood sugar readings with his glucometer for comparison.
We liked it a lot. We had no trouble keeping it in place, even on a toddler, and it was great to see all the data right there. Unfortunately, we had to give it back (we were part of a clinical trial; that was six years ago, and I don’t know if that model has come to market yet). OTOH, his blood sugar has gotten a lot easier to manage as he’s gotten older and has a regular insulin schedule, so that’s probably actually better. 🙂
I’m so on board with that bionic pancreas. My son had to have most of his pancreas removed as an infant, which is why he has diabetes (something called “post-surgical” diabetes that’s like Type 1, but far easier to manage, at least so far). My husband thinks xenotransplantation is the way to go, because he thinks it would be cool to have a kid with a pig pancreas, but I’d rather have a cyberchild. Especially if I could program him to, say, clean his room or use shampoo on a regular basis.
Good luck with whatever you decide to do!
April 25, 2014 @ 10:52 pm
I just finished Codex Born, and was checking out your blog to see if there were any estimates for the third book in the series (which is great by the way.) I have enjoyed some more lighthearted reading since finishing WOT, between these two, and the Iron Druid Chronicles (Kevin Hearne) I have really been enjoying myself.
Anyway, I saw this and discovered that you are a T1. I want to say that it is pretty cool, but, yeah, having T1 isn’t really cool. It is cool to see other people, especially well-known people, that have the same thing I do and can relate. I tried the whole CGM thing for a while a couple of years ago and ended up giving up on it. I have heard that the new Dexcom is quite a bit more accurate though, and less of a hassle than the Medtronic one that I have. I just upgraded to a T-Slim pump from Tandem, and have been thinking about getting a Dexcom sensor soon too.
Thanks for making some cool books man, I look forward to having more to come.
Jim C. Hines
April 29, 2014 @ 10:43 am
I know what you mean. The disease is a pain in the ass, but it’s cool connecting with other folks who deal with it and have a better idea what you’re going through from day to day.
I did a bit of reading, and it sounded like the Dexcom did a better job than the Medtronic CGM. If I decide to try to get one for myself, I’ll have to do a lot more reading to be sure, though.
And thanks for the kind words about the Magic ex Libris series! I’m told Unbound should be out in early 2015, but I don’t have an exact release date yet.