630G End of the Trial Period

So on Monday, I put my VEO back on.  I wanted to put it back on so badly on Friday, but the sensor wasn't quite over and the reservoir ended a little too early.  So I sucked it up and wore the 630G for three more days.  I've been so much happier with the VEO back on, with one caveat: the 630G is way handier when you're adjusting basal rates.  It's a huge pain that the VEO doesn't remember what you had programmed in as later basal times when you have to change an earlier one.  But other than that, I'm so much happier

Over the course of the last two and a bit weeks, I discovered that there are quite a few things I actually hate about the 630G. 

• I know I mentioned that I have to turn the screen on to see the time.  Well, a week later, I've found that I REALLY hate that the screen turns off! I looked into the settings to see if I could have it always on - the longest you can leave it on is apparently 3 minutes. What a pain.  Of course, having the screen always on would cause its own problems while you're running a sensor, since the graph and glucose level would be visible for anyone else to see - and it's not their business. 
• The battery life is terrible because the screen is full colour (and probably also partially due to the amount you need to turn the screen on/the extra button presses).  One battery lasted just shy of two weeks (I turned the pump on at around 11:30pm, May 5th.  The battery gave me a "there's 30 minutes left of battery power" low battery warning just before 7:30pm on May 19th).  So it's great that it uses AA batteries instead of AAA's, but you'll burn through way more of them so it won't actually save you any money.
• YOU CAN'T TURN THE SOUND OFF!!!!!!!  The pump has the "Audio Options" near the top of the menu.  The first option in there is to turn the pump sound off.  But when you click on it, NOTHING HAPPENS!!!!!  (Believe me, I tried it multiple times).  Also, if you try to turn the sound down, you can, but it will not go to 0.  After the annoying beeping during the aqua jog class, I wanted to be able to silence it for times like that in the future.  But nope. WHY IS THIS EVEN A MENU OPTION IF IT DOESN'T WORK????  WHY CAN'T YOU TURN IT TO SILENT???  (*I realize you can't turn the sound off on their other pumps either, but seeing the option made me really upset that it was a fake option)

Oh, I don't necessarily hate this, but it's very annoying that there doesn't appear to be anything telling you that you're on a different basal pattern. So I spent the weekend using the new workday basal pattern I created without realizing it until Sunday (and was a bit higher than I should have been as a result).  

In addition to this list, there were many things I very much disliked after using it for one week. All in all, I have been very disappointed in this pump.  I was super excited for it when I first found out I could get it (and also after playing with it at an information session).  But after actually using it, I would hate having it attached to me 24/7 for the next few years.  I'm glad Medtronic let me have this trial period with it though - I would have been super upset if I had waited to get a new pump and didn't have the VEO to go back to.  I've been a fan of their pumps for years - this one is the first one I haven't liked.  I hope they'll fix these issues during the next few years, or else when I eventually need to replace my VEO, I may have to go looking elsewhere for a pump.

630G Sensor Trial Part 2

Alright, so I've had a successful six day sensor run on the 630G.  I was thinking that the sensor experience may totally make or break this pump.  Either it was going to be absolutely fantastic (and I would have to seriously reconsider whether my original misgivings/complaints were things I could live with), or I was going to continue to be disappointed with the whole 630G experience...

I know that I am a bit biased because the first sensor didn't work properly (which may have been why the 630G insisted on that calibration exactly 6 hours later the first time - I don't know for sure if it needed a calibration exactly 6 hours later the second time, but I also was super careful to do a calibration as close to 6 hours later as possible to avoid having to do extra blood tests).

Here's a fun (read: annoying) fact: when you are calibrating a sensor, it says "Calibrating" across the sensor graph on the main screen...and also the other sensor graphs unless you actually start looking over them. 

Here's the main 630G pump screen.

And here's when I specifically selected the sensor graph.

I know that it goes away on the sensor graph if you select right or left in an attempt to read the sensor graph.  I also know that the whole "calibrating" thing goes away once it's done calibrating in about fifteen minutes.  But I honestly don't understand why it's there at all (I know it's calibrating - I TOLD THE PUMP TO CALIBRATE!!!) and ESPECIALLY why it has to take up room on the sensor graphs off the main screen (I ALREADY SAW YOU WERE CALIBRATING ON THE MAIN SCREEN, PUMP!!!) Again, I realize it goes away after about fifteen minutes, but this was such a weird and annoying addition.

Through the entire life of the sensor, I found that my sensor glucose was consistently about 0.5-1.5 mmol/L off all of my blood sugar readings.  This has never been the case with the VEO, especially after the first day or two of running a sensor (it always gets super accurate from about that point for me).  So this was pretty disappointing because I had heard that this transmitter was supposed to be more accurate.  And I actually found myself not caring what the sensor was telling me because it wasn't overly accurate anyway - it was at the point that I was counting down the days to it being over because I hated dealing with.

Oh, and when I finally got to pull the sensor out, it looked perfectly fine.  So I don't know what it's problem was for the entire six days.

As you may have guessed, I ended up turning pretty much all of the fancy alerts off.  I had already turned the low suspend off thanks to the failed sensor.  But it was also annoying on the other end, being told I was going high/was high when I knew I wasn't (and confirmed it with a blood test). 

Needless to say, I would not be trusting these sensors/this transmitter with a closed loop system.  I don't trust my VEO with it, but it's a heck of a lot more accurate than the 630G was for me. 

Weight Update for May 21

And my weight continues to yo-yo. :(

weight: 207.8 lbs
fat percentage: 45.2%
hydration: 37.6%
muscle: 27.0%
bone: 10.7%
cal: 2333

At least my fat percentage came down slightly.  And my muscle increased slightly.  I have no explanation for why the weight has increased so much though (unless it's because my period is coming....)

Weight Update for May 16

I didn't remember what day I last weighed myself, so I decided to do so this morning.  Here are my numbers:

weight: 205.4 lbs
fat percentage: 45.5%
hydration: 37.6%
muscle: 26.8%
bone: 10.8%
cal: 2319

I'm very happy to see my weight going in the direction I want.  But some of the fact that the muscle and fat has increased is kind of weird.  I actually tried a water aerobic class last night, so there's no reason for the increase.

The class I tried was called "Aqua Jog."  You attach yourself to one of the lane ropes using a bungee cord and a floating belt thing. This holds you in place so you don't have to concentrate on staying afloat; you're free to concentrate on the actual exercises instead.

An example water belt.

I've never tried a water aerobics class before; I had a lot of fun.  The class is split into three segments: first it works your lower body, then your arms, and finally your core.  I really felt like you got out of it what you put into it...so if you really worked at it, you would feel the burn. This was the type of class that I wouldn't go to every week, but would definitely go back to here and there.

Hilariously (kind of), the 630G was obnoxious through the whole class.  I'm running a sensor, and it lost the signal part way through (I took the pump off because I don't have a good way to attach it to my bathing suit right now - plus I had no idea what the class would be like and didn't want to risk it getting in the way).  It started beeping loudly; I had to detach myself from the rope to silence it.  But I didn't realize the pump was still looking for the signal; it started loudly beeping again like ten or fifteen minutes later (and I had to detach myself again).  While this was super annoying, thank goodness I brought the pump with me to the poolside; otherwise it would have been freaking out inside the locker room without me around to silence it.  I didn't think of it at the time, but I should have turned the audio off; maybe then the pump would not have been so disruptive (but I don't actually know - maybe the alerts for this wouldn't be silenced?  I'll have to try and see later).

630G Sensor Trial Part 1 (Failure)

Last night, I started trialing a sensor with the new 630G pump.  And I ended up having a night from hell.  I started off low.  After correcting the low, the sensor kept insisting I stayed low.  This went on all night long (does this sound familiar? This exact scenario happened back in November, too).  As part of the trial, I had the low suspend turned on.  Part way through the night I had to turn it off because I wasn't able to sleep worrying about my insulin being turned off on me.  Then I also had to turn the alarms off so I could sleep. 

Oh, I didn't realize the 630G would insist on a calibration 6 hours after the first one.  I did a calibration an hour earlier than that, thinking that would be fine.  Apparently it wasn't.  An hour later the pump woke me up insisting on a new calibration.

So then I woke up around 11am this morning and did a calibration (the pump was still insisting I was super low when I definitely wasn't). The pump refused to accept the calibration.  Around this time I turned the sensor off and reconnected it, then did the second calibration (with a new glucose reading).  That one failed, too.  But this time the pump also told me to change out the sensor.  So I phoned Medtronic right away to troubleshoot.  We ended up pulling the sensor; it had a slight bend to it.  Apparently the calibrations also fail when the number is something the pump isn't expecting (so quite a bit higher or lower than the pump/sensor/transmitter all think it should be). 

So now I'm starting a new sensor. Hopefully this one will work better.  As a precaution, I used the sensor inserter-thingy that I got with the VEO rather than the one with the 630G.  They're very similar (and the one with the 630G is honestly easier to use, requiring less steps), but I'm worried that when I used it (and was confused because I didn't realize it needed less steps), something went wrong on insertion.  This insertion seemed to hurt a bit less than yesterday's, so hopefully this is a good sign for the week!

Weight Update for May 9 and May 13

Here's May 9th:

weight: 206.0 lbs
fat percentage: 44.1%
hydration: 38.4%
muscle: 27.5%
bone: 10.7%
cal: 2323

And here's May 13th:

weight: 207.2 lbs
fat percentage: 44.3%
hydration: 38.2%
muscle: 27.4%
bone: 10.7%
cal: 2329

That definitely went in the wrong direction.  But that's not super surprising - I went low last night and had to eat a lot to get back to normal.  I'll be detailing that though when I talk about running sensors with the 630G.

630G Trial Period

So here it is: my 630G:

It's currently warming up as I attempt a sensor with it.

As I said back when I got my VEO, I am able to upgrade to the newer pump if I want to.  I have a 90 day trial period, after which I will have to send either the VEO or the 630G back.  Medtronic told me to take my time on making the decision, because once I decide and send a pump back, that's it (I won't be able to change my mind).

So I've been running the 630G pump for about a week now.  I was super excited to try it.  Back a few months ago I went to an information session and got to play with it; it seemed really, really awesome!  But first impressions while playing with it for a few minutes are not the same as wearing it for a week.

So first, what I like about it so far:

• Access to the basals (including patterns and temporary basals) is super convenient on the main screen!
• It's water-proof!
• Basals are easier to edit because the pump remembers subsequent lines!
• You can have up to 8 basal patterns (I think the VEO has a max of 3)!
• It runs on AA batteries, not AAA's!

What I do not like about it:

• When the screen goes to sleep, upon waking it you have to unlock it.  This is super annoying, adding extra unnecessary button presses. And the worst part: YOU CAN'T TURN THIS FEATURE OFF!!!! (I do understand why the feature exists - to make it harder for children on the pump to give themselves extra insulin. But I have been on a pump for years and have never accidentally bumped the pump and given myself extra insulin. The extra button presses are annoying!!!)
• The menu layout is actually really terrible.  On the VEO (and all the old Medtronic 500 series pumps that I've used), the most important features are first (like bolus settings, suspend, sensors, and basals). On the 630G, the insulin settings are fifth in the list, sensors are sixth. (I know you can access insulin settings from the bolus and basal options on the main screen as well, but I'm looking at it just from the main menu). I don't see why audio options, history, AND resevoir/tubing are all above sensors and insulin settings.  Suspend is thankfully still near the top.
• I have to turn the screen on to see the time. With the older pumps, the time is always visible on the screen (you just hit a button to turn the light on if it's dark).
• I can't find the history of when I did my last reservoir and set change without manually going through the daily history. (I guess you can turn a reminder on to do the set change, but the reminder I set for two days went off after just one for some reason, so I turned it off).
• Changing the reservoir takes even longer than it did with the VEO (that was the one thing that really annoyed me with the VEO - I get it, they want to make sure new pump users are comfortable/have proper guidance. But for myself, I find the extra steps and button presses SUPER ANNOYING).
• The screen doesn't rotate.  This doesn't bother me most of the time, but there have been a few times where I've been annoyed that I couldn't see what I was doing and had to grab the pump.

Things I am disappointed about it:

• I was super excited to hear that the glucometer functions as a remote for the pump, letting you bolus from it. Unfortunately my expectations were a little too high - I thought I'd have access to the bolus wizard from the glucometer.  No, I do not.  It literally functions like my old remote (but a bit improved), letting me manual bolus only.  Well, and use preset boluses, but I don't know why I would bother to program in a preset bolus. 
• The basal rates are like the VEO - you get awesome fine-tuning options if you need less than 1 unit an hour.  As soon as you hit 1 unit+, you have less fine-tuning abilities.

To be completely honest, when I discovered that I couldn't turn the screen lock function off, I was ready right then and there to send the 630G back. But I want to make sure I give the pump a fair trial period (maybe I'll get over it....?). And for that to happen, I also need to run a sensor.  I've heard that the sensors are more accurate with the 630G, so I'm starting one tonight and will report back once it is over.

Fitbit Weight Goal Rethink

Somewhere along the way, I set my Fitbit's weight goal as 165lbs.  I have been struggling to get anywhere near that goal.  And in some ways with good reason - it's SOOO FAR AWAY (we're talking about 40lbs to lose right now).  This was made even more depressing when I entered all my weights into the Fitbit app yesterday, where I have basically yo-yo'd between 5lbs for the last year.

So I had an epiphany yesterday - why don't I set the goal to something a bit more manageable?  Instead of trying to lose the whole 40lbs, why not set a smaller goal instead?  After a bit of thought (and at Fitbit's suggestion), I decided to try to lose 10lbs right now (and get my body fat % down 5% to 40%).  Hopefully this will be better motivation!!!

Standard Deviation

Thanks to chatting with a friend today, I just discovered standard deviation and what exactly it means for blood sugar control.  How all this came about was when a friend of mine who also has Type 1 and I were talking about basal rates and sensors, he said to look at my standard deviation.

If you're unfamiliar with standard deviation in regards to blood sugar, here's Lloyd's handy explanation that he posted on Diabetes Daily:

Standard Deviation, often abbreviated SD, is a measure of glucose variability.

From "Pumping Insulin", by John Walsh and Ruth Roberts, page 19:

"Emphasis is rightly placed on high blood sugar levels as a cause for damage, but evidence also points to up and down or unstable readings as an additional culprit."

Standard deviation is obtained from insulin pumps, and some glucose meters (including cgm) and the programs that the meters and pumps upload their data to.

What are we measuring here? We are measuring how tightly packed your readings are around your average, or to state the opposite, how widely scattered they are.

If you yo-yo all day from high to low and back, that will show up as a high standard deviation. If you are very stable, without many highs or lows, that will show up as a very low SD.

The lower the number the better.

What is a good number? Walsh says get it under 65 mg/dl (3.6 mmol), or under half your average glucose for a type 1.

As a type 2, I have found that it is easy for me to do much better than that. I started pumping at a SD of about 25 mg/dl (1.4 mmol). Now, 7 months later with no highs and very few lows, my SD is 15 mg/dl (.83 mmol).

Say your average is made up from a 250 (13.9) and a 50 (2.8) averaging 150 (8.3). The 150 (8.3) average is not bad, but the 50 (2.8) is too low and the 250 (13.9) is too high. So if you only look at the average, you might think you are doing well, when in fact you are not doing so well.

Looking at a standard deviation will tell you if your average is made up of good numbers (great!) or high numbers and low numbers averaging themselves out (not good).

-Lloyd

So in the context of my conversation, basically my friend was saying that if I set my target for 6mmol/L throughout the night, but my standard deviation is +/- 3.0mmol/L, then my glucose will vary and there is a good chance I will have lows. If this hypothetical scenario is true, then if I set my target to 7mmol/L, then I shouldn't be going lower than 4 throughout the night.

I'll have to keep this in mind when setting glucose targets!

Huge Update

Ok, I've got a whole bunch of things to write about, so here's a huge update.

First, weight.  Here are my numbers from April 20th:

weight: 206.8 lbs
fat percentage: 45.0%
hydration: 37.8%
muscle: 27.1%
bone: 10.7%
cal: 2327

And May 1st:

weight: 208.0 lbs
fat percentage: 44.9%
hydration: 37.8%
muscle: 27.1%
bone: 10.7%
cal: 2334

Some things that happened over the last few months.  First there was an ice storm that closed the city down (so exercise was a bit harder to do during that time).  It was also my dad's birthday, so I was eating a bit worse than normal (ie eating cake).  Also I had a bit of a life change regarding one of my jobs (a major reduction in hours), so while the sudden free time has been nice, I've noticed myself boredom snacking.  Since I'm aware of it happening, I need to take steps to stop it from happening (or at least to only have healthy snacks around the house, which is a good idea anyway).

Next: swimming. I may have actually discovered a better insulin strategy for swimming today.  Normally I do 45% of the basal, and about 45% of the bolus at lunch or dinner before going.  Today I started out a bit higher than normal (I was about 12 mmol/L), so I decided to do my regular bolus for food at lunch (but I didn't do the correction).  Then I backed off my basal to I believe 50% like an hour and a half before I went swimming.  This worked beautifully! I wasn't super high to start out, my glucose didn't go super low while swimming (it actually only went down by about 1 mmol/L over the 40 minutes I was in the pool).  When I was able to do glucose, I did a correction like I normally do to get a bit more insulin working after being disconnected; a couple of hours later, I'm still in about the same glucose range as when I started (which is awesome - my glucose didn't shoot up!)

I bought my membership at the pool back in January.  Today I sat down to figure out the math of whether or not I've been getting my money's worth out of that membership.  The short answer is no, I have not.  In February it more than paid for itself.  But every other month I've fallen short (with March being super bad because I only went once).  To get my money's worth, I have to go swimming 6 times a month.  To get caught up with the money I have thus far wasted in January, March, and April, I will need to fit in an extra 7 times over the remaining year.

I also have to remember that my membership isn't just for the pool - I can use the whole gym facility.  Like last night, when I didn't feel like going swimming because it was miserable and cold out, there was no reason why I couldn't have grabbed some indoor shoes and my iPod and just walked around the track!  I'll have to keep that in mind going forward.  And I really should hit up a yoga class at least once (I just don't like the times they're all at - maybe the summer will have some afternoon classes?)

Finally, my Fitbit stats for April.  I took 180,912 steps over 28.5 days, which averages out to 6348 steps a day. That's 64,027 steps more than last year, bringing my average step count up by over 2000 steps from last year.  Not bad!  :)

I also had three weeks over the last month where I hit my goal of walking 5000+ steps on five days of the week! That makes April the best month so far in regards to that goal (February was my next best month).  Go me!