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Canada's Original One Stop Shop for Insulin Pump Supplies est 2004

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CGMS-Continuous Glucose Monitoring Systems

Monday, October 27, 2014 4:15:58 PM America/New_York

I have been using CGMS since 2007 because it allows me to better manage my diabetes. My current Veo Medtronic pump works with the Enlite sensor to measure my interstitial glucose level every 5 minutes. This level correlates with my blood glucose and is displayed as a graph on the insulin pump. You may ask, why is such close monitoring necessary? Dr. Steven Edelman of UCSD said it best when he made a presentation at the Best Center (Ajax), Type 1 Diabetes Educational session May 2013, “ I use CGMS because every day is different”. This is very true. We do not expend the same energy, or eat or experience exactly the same stress every day. CGMS allows a user to micro manage his/her diabetes because we can see the trend of the glucose level and make decisions regarding more or less insulin or more or less food instantaneously. In my own personal situation, I experience some delayed digestion (gastroparesis) and CGMS allows me to gauge my insulin needs. I have experienced a reduction in A1C of ½ percent (7.2 to 6.7) with the help of CGMS.

There are 2 CGM systems available in Canada. Animas sells a standalone CGM system called the Dexcom G4 Platinum CGM as well as the Vibe Insulin Pump which features Dexcom CGM. Medtronic sells a standalone CGM system called the Guardian as well as the Veo Insulin Pump which features the Enlite CGM system. Each system has a disposable sensor which is specific for their system.

Anna of http://www.insulinindependent.com/ has written a blog comparing both systems. Anna is based in the UK where these systems were available before they were introduced in North America.

An adapted version of the chart on Anna’s blog

http://www.insulinindependent.com/2013/07/dexcom-g4-vs-medtronic-enlite-low-down.html

 

Vibe with Dexcom G4

Medtronic Enlite

     

Calibrations needed

2 per day although more results can be entered

2 per day. No more than 4.

Length of wear (according to manufacturer’s guidance)

7 days (CE approved)

6 days (CE approved)

Actual wear by customer’s choice (not advised)

Personal experience of between eight and 36 days wear before sensors expired

Personal experience of only 8 days before sensors expired

Comfort

Extremely comfortable. Longest time worn for 36 days ith no irritation and very small entry hole.

Extremely secure when in place

Comfortable.

Longest worn for 8 days, but aware of the sensor site at this time and reasonably irritated on removal.

Not as secure feeling when in place

Integrated into pump

Yes, only with Animas Vibe

Yes, only with Medtronic Paradigm Veo

Low Glucose suspend (safety feature to suspend pump temporarily when hypo)

No

Yes , when integrated with Paradigm Veo pump

Alarms

Very good. Audible, simple, easy to amend upper and lower limits

Good but less audible when pump under covers. Somewhat over sensitive (alarms when changing very slightly).

Paracetamol use while wearing sensor?

No. It interacts with the fluid giving a false high

Yes. No issue with fluid interaction.

Range

20 ft, can work between rooms (with stand alone unit)

6 ft (with standalone unit)

Accuracy (MARD score – the gold standard of glucose testing. The lower the MARD, the more accurate the device is considered)

14%

15.3%

Sensor technology has been improving over the last few years with smaller and more sensitive sensors however they still require calibration with a blood glucose meter 2-4 times daily. CGMS will not eliminate the need for a finger poke. Coverage for the sensors is not universal. Some insurance companies pay for these while many do not.

If you have used CGMS, please share you experiences with others through this blog.

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Posted in Living With Diabetes Products By Tino Montopoli

Tell Us Your Storey: Lisa Peterson

Wednesday, September 17, 2014 12:42:38 PM America/New_York

Lisa PetersonWhen I was eleven months old, I had just enjoyed my first Christmas when I came down with strep throat. My parents took me to the local hospital, which diagnosed the strep virus. To help prevent dehydration, they put flat 7-Up in my bottle and held me overnight for observation.

The next day I was released to my parents, who were horrified to discover I was unresponsive.

"She's just sleeping hard," the nurses told my frantic mother, but she insisted I be seen again by the doctor. When he finally made his way over to see me, a huge mistake had to be acknowledged. My blood test from the previous day was over 800 mmol in US measurements (over 40 in Canadian measurements I guess?), and the hospital had very effectively put me into a coma with the 7-Up supplement.

At this point the local hospital was beyond its medical abilities, and I was loaded into a sheriff's car with my mother while Dad drove behind us to the larger hospital 100 kilometers away. There, the specialist stayed with me 24/7 in the three days it took for me to be revived. And my life was changed!

Upon departing the first hospital, the doctor confidently stated to my mother, "She will always be a brittle diabetic." Not even sure what that meant, Mom did know it meant I would never return to that facility. Thanks to our local, country doctor, a better clinic was found to help ensure the future of this infant diabetic. The clinic was in St. Louis Park, Minnesota, a suburb of Minneapolis, and a four-hour drive from our home. My new doctor's name was Donnell Etzwiler, a young, new doctor who had made it his mission to not treat juvenile diabetes by reacting to the symptoms, but to control the symptoms by helping his patients balance their diet, insulin and exercise.

Remember that this took place in 1968. At that point, the only blood sugar readings were obtained by drawing IV blood. My heavy syringe was made of glass, with a stainless steel needle that had to be sharpened frequently by my father. Both the syringe and needle had to be boiled before re-using, and then stored in a vial of alcohol. Mom would test my sugars by squeezing the urine out of my cloth diapers (no disposables for those either!), and the record-keeping began to balance insulin and food for a child who could not yet communicate if she was feeling bad.

Time pressed on, and Dr. Etzwiler was gaining renown with his clinic for creating a food system based on "exchanges" to help diabetic patients monitor their food intake. Food was not packaged with labels at that point, to indicate how many carbs or calories it contained. If you were lucky, it did list the ingredients, allowing consumers to tell how high sugar ranked in the contents for guidance in what might not be a good dietary choice. For instance, "Wonder Bread," a treat I only dreamed of having for lunch, was loaded with extra sugars in comparison to standard white bread.

Originally located at the St. Louis Park Medical Center, Dr. Etzwiler's diabetes education centre was soon moved across the highway to a huge new facility that is still world-known, as the International Diabetes Center.

However, as I progressed through school, taking part in a variety of activities but always passionate about my interest in horses which took up all of my out-of-school time, I had to part ways with what had become a mainstay in my life. Upon graduating from college with a liberal arts major, I launched myself on a summer internship to the unknown country of "Vermont." So far from my family and diabetes support system, I was now catapulted into being completely responsible for my own well-being, and creating a support network for myself.

The summer internship turned into a 12-year career, working for the American Morgan Horse Association. This pursuit found me jetting across the U.S. and on occasion Canada, to attend Morgan horse shows and run our promotional booth at equine events. It was a thrilling job for someone who lived and breathed horses, and came with it's share of diabetes challenges. By now though, I had access to the wonders of blood sugar monitors, disposable syringes, and a world of confidence that I could take on any challenge. Ah, the immortality of youth!

Fortunately, my missteps were few and manageable. On occasion a roommate would need to call 911 when I had overdone it at the boarding stable where I kept my own horse, and made the error of not eating enough to compensate for the calories my body continued to burn into the night. Remember there was no carb-counting still at this point, we were still on food exchanges! I suppose this accounts for why my body has become so finely tuned to the feelings of fatigue. Even if I truly am just tired, my metabolism screams at me to inhale carbs until that uncertain tipping point has been avoided. Although usually with a very high blood sugar level as a result.

After spending a year in Vermont, I realized this might be a permanent situation and I would need some medical support. So, I called the nearby university hospital and asked for a diabetes specialist. I suppose I had become a bit spoiled by the comprehensive, cutting-edge treatment I had received in Minnesota all those years, for the experience of explaining my life to the medical student and then the doctor left me feeling more knowledgable than they were. And when I exited the exam room to find the entire Endocrinology wing lined up to meet a 22-year long patient of the famous Dr. Etzwiler, I was flabbergasted! Talk about my ten seconds in the spot light!

Fortunately, the endocrinology department did improve after that, and I still chuckle at the specialist asking me, "Why are you even coming here? You know more about how to take care of yourself than we do! Come back whenever you want, but I don't expect to see you unless you have trouble."

Wow. Taking that doctor's guidance, I did stay pretty well removed from the clinic, unless I was having problems finding the right adjustment for my insulin.

So it was I became a bit of an independent diabetic, still feeling pretty immortal. Now my stable life took a bit of a bump, when I was introduced to a fellow from the GTA. One thing led to another, and before long I found myself migrating south, from Vermont, to a dream farm north of Toronto, Canada.

Upon discovering I was pregnant a few months after our marriage, I was now the frantic mother. How could a diabetic possibly have a healthy child? Fortunately, I was well behind the times on diabetic pregnancies. A specialist and local gynocologist were found as quickly as possible, and I navigated the rocky waters of sustaining a new life by keeping my blood sugars the most tightly controlled they have ever been. That went so well, I had a second child, and both are well and thriving on our small farm.

Shortly after my second child was born, I began having a variety of health problems. Burning skin rashes, loss of sensation in my feet, chronic diarrhoea, and exhaustion were attributed to a variety of things, but I knew it had to be complications of my diabetes. However, upon having my iron levels tested, it was discovered I was anaemic.

Further testing revealed that I have celiac disease, a complete intolerance to the gluten protein found in wheat, barley and rye. Thrilled at this diagnosis, as I was sure my lifelong partner had finally gotten the best of me, I adjusted my diet, once again, and have been going at 110% ever since.

And this leads to an amusing anecdote. My grandmother's family have all been long-lived, thriving into their 90s. I often joked that I must have gotten a double dose of their strong immune systems, as mine turned on my own body when I became diabetic. As fate would have it, my great aunt from this side of the family was also diagnosed with the Celiac immune disorder after having her children in the 1960s. So really, I wasn't too far off. Both long life and immune disease are in the genes!

As my marriage ended after seven years, I was launched into yet another life challenge: Not only supporting myself and two children, but dealing with the constant exhaustion of juggling so many balls at once. Fortunately I have always loved an impossible situation!

At this point I maintain my health by constantly checking my sugars (a continuous monitor is far beyond my means) and being exceptionally active. Still on the farm, I have indulged my farm girl tendencies by developing a growing business that produces pasture-raised chickens, eggs and pork for the health-oriented community, and I have opened a small farm store for people who have been searching for a local source for these products.

I also do property descriptions for one of Canada's top realtors, and produce a magazine five times a year for a Canadian horse association, keeping my horse knowledge alive and well. With both children in school, I am immersed in volunteer activities, including salvaging the weed-choked school gardens which I am especially proud of after three years of constant mulching, weeding and finding durable flowers for this high-traffic area.

You never know what life has in store for you when you land on this diverse planet, but it has been a lesson in amazement at the variety of approaches we have to living a long and fulfilling life. As a diabetic for 47 years now, I am not controlled by my disease but a companion to it. I have seen our approach change from one of suffering until the complications set in, to seeing people live with this condition as if it was a minor skin irritation. Science is getting closer to letting us live with a better treatment than the constant injections and finger-pricks.

When I was eight years old, I remember walking home from the school bus and gazing up at the fall foliage through my new glasses, and wondering if I could remember every little detail of the sun illuminating their colours, for when I lost my vision as I had picked up was very likely to happen when I got older. Today I am still wearing glasses and my vision is just fine, thank you ver much. But I still lose hours gazing (and listening and smelling) at the wonders of the world around me and finding my most effective place in it.

Lisa Peterson

 

Have a story you wish to tell about your life with diabetes?
Fill out the form found at http://www.diabetesdepot.org/diabetes/tell-us-your-story and we will post it on our website.

Posted in Tell Us Your Story By Tino Montopoli

Dealing with Diabetes during Illness and Hyperglycemia

Monday, July 14, 2014 1:08:26 PM America/New_York

Having an illness or infection can make it particularly difficult to manage blood glucose levels. A little knowledge of how illness affects diabetes can go a long way towards helping you get through it.

An illness like a cold or virus infection is considered a stress to your body resulting in your body releasing stress hormones or counter-regulatory hormones. These hormones will cause a release of glucose from the liver and muscle resulting in blood glucose levels increasing often to very high levels. In addition your body becomes more insulin resistant which means you will often need more insulin than usual.

When there is not enough insulin available, blood sugar levels rise and excess sugar spills into the urine. The body then starts breaking down fat as an alternative supply of energy. The ketones produced by fat breakdown are acidic, causing Diabetic Ketoacidosis (DKA) which may be life threatening requiring an emergency room visit as soon as possible. As the condition worsens, and more and more water is lost in the urine and through vomiting, you may become increasingly dehydrated. DKA can be avoided by careful attention to all aspects of the diabetes treatment plan. DKA usually develops over hours or days.

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Posted in Living With Diabetes Guides By Tino Montopoli

The Diabetes Depot recognizes the Importance of reaching your A1C target

Monday, May 19, 2014 2:47:59 PM America/New_York

According to the Diabetes Mellitus Status in Canada Study (DM SCAN) only 50% of persons with diabetes (PWD) reach an A1C of 7.0% or less. An A1C of 7% is set as the target by the Canadian Diabetes Association’s Clinical Practice Guidelines in 2013 for most people with diabetes.

You may ask what is A1C or Hb A1C or glycated hemoglobin? In simple terms it measures the percentage of hemoglobin (found in red blood cells) that have glucose attached to them. This occurs to a greater extent when blood glucose levels are elevated. The A1C is reflective of the blood glucose over a 2-3 month period as red blood cells have an average life span of 3 months. As the older ones die off the body produces new ones. The chart below shows that an A1c of 7% is reflective of average blood glucose of 8.5 mmol/L.

A1C level (percent) Estimated Average BG level
5 5.4
6 7
7 8.5
8 10.2
9 11.8
10 13.3
11 14.9
12 16.5
13 18.1
14 19.7

http://www.mayoclinic.org/tests-procedures/a1c-test/basics/results/prc-20012585

So how does one go about achieving their target A1C? The simple answer is to balance nutritional intake with insulin and physical activity if you have type 1 diabetes. In the case of type 2 diabetes, other medications may be used to reduce blood glucose. The purpose of this blog is to focus on those type 1’s who use an insulin pump.

When A1c runs fairly high (10), most of the A1c comes from the fasting or blood glucose before meals but when A1C is in the range of 7.3 or less most of the A1C comes from the glucose levels after a meal. This is called post prandial glucose and one typically measures this 2 hours after eating. It is this post prandial glucose level that gives many people problems. This is especially problematic at breakfast. By definition this meal is meant to break the fast and provide energy or carbohydrates after fasting overnight and so traditionally this meal was mostly carbohydrate. This presents a problem for anybody that cannot produce or secrete their own insulin especially if these carbohydrates are high glycemic index foods or processed foods. These high GI foods are quickly digested resulting in blood glucose levels soaring!!! How can you deal with this issue? Choosing low glycemic index carbohydrates will help. Some examples of low GI morning cereals are All Brad, Bran Buds with Psyllium, and Oat Bran. Some examples of high GI cereals are Cheerios, Corn Flakes, Rice Krispies. For more informations about GI and examples go to http://guidelines.diabetes.ca/CDACPG/media/documents/patient-resources/glycemic-index.pdf. Another way to subdue post prandial BG is to have a balanced meals which includes a varieties of food groups – protein from meat or meat alternatives, fruit, milk or milk alternatives. A mixed meal with high fibre low GI foods eaten in proper portion sizes will usually result in lower blood glucose levels (2 hours after) in comparison to a meal of low GI foods only.

Posted in Living With Diabetes By Tino Montopoli

Diabetes Depot on Physical Activity and Hypoglycemia

Monday, April 21, 2014 2:43:47 PM America/New_York

Physical activity or exercise has been associated with many health benefits. These include improvement of mood, sleep patterns, energy level, blood pressure, lipid levels, insulin resistance and reduction in risk for heart attack, stroke and death. Wearing an insulin pump is not a barrier to physical activity.

Sports and other forms of physical activity almost always improves glycemic control in persons with T2 diabetes. However physical activity may not improve blood glucose control in persons with T1 diabetes as it may complicate control or make management of blood glucose more challenging. Hypoglycemia is a major concern in T1 DM and to a lesser extent in those with type 2 diabetes using insulin or drugs that stimulate the pancreas to release insulin because PA usually causes a decrease in BG and so an adjustment would be needed to account for this decrease. Suggestions to reduce the risk of hypoglycemia are:

  • test BG before starting PA and if BG is < 5.5mmol/L approximately 15 to 30 gm of carbohydrate should be consumed. The actual amount will be dependent on injected insulin dose, exercise duration and intensity, and results of blood glucose monitoring.
  • test during PA if duration longer than 1 hour
  • test again after PA
  • consume extra carbohydrates for the activity. John Walsh refers to these as Excarbs. Refer to his chart which specifies how many carbs are required for specific activities based on your weight. Please note these are just approximations. http://www.diabetesnet.com/node/237
  • reduce amount of mealtime bolus insulin required before a meal and exercise after the meal. For example if you consume 60mg of carb but only bolus for 30gm
  • reduce basal insulin (if using an insulin pump) starting 60-90 minutes before exercise
  • a combination of the strategies above ie extra carbs and reduced basal insulin for a few hours starting a hr before PA. This strategy require some practice before you get it right.

Extended periods of physical activity or vigorous activity of shorter duration may result in hypoglycemia many hours after the activity. This kind of activity may deplete the glycogen stores found in muscle which normally provide glucose during extended activity. Hours later glucose is pulled from the blood stream to restore the glycogen stores which may result in hypoglycemia during the night. Reducing basal insulin during the early morning hours may reduce this risk. Alternatively extra carbs at bedtime may be consumed without a bolus dose of insulin. Testing during the night is recommended.

I experienced this hypoglycemia hours later the activity last winter when I skied for 6 hours at Sunshine Valley (Banff). That evening we went out to a pub and consumed some beer. During the night I experienced hypoglycaemia despite reducing my basal to only 30% of normal while skiing. You can guess what happen…….glycogen stores were being replenished and pulling glucose from the blood stream. To make things worst alcohol inhibited the liver from releasing glucose which further increased the risk of low blood glucose.

Yes, this all seems like a lot of work but after a while you will see what works and what does not work and it becomes easier to manage. Remember to always have fast acting carbs ready and medical ID is recommended. Continuous blood glucose monitoring systems are extremely useful in these situations.

Posted in Living With Diabetes By Tino Montopoli

Saving Money on Infusions sets

Friday, March 14, 2014 2:09:00 AM America/New_York

There are a number of ways to stretch your dollars when purchasing your infusion sets. Consider using a combination package. Some sets are available with 10 sites and 5 tubing sets with the idea that the tubing may be used for 6 days while the sites (Teflon) may be changed every 3 days.

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Posted in Living With Diabetes Guides Products By Tino Montopoli

Video Guides

Friday, February 14, 2014 2:04:23 AM America/New_York

We have recently added 2 new videos to our website

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Posted in Guides By Tino Montopoli

Simplicity of Steel Infusion Sets

Friday, February 7, 2014 1:58:22 AM America/New_York

Why use a steel set? They will not kink which is a risk with any Teflon set. The gauge or thickness of steel is much smaller that Teflon so that when you change sets there usually is NO trace or wound. Anybody using Teflon will see a small hole that scabs over as it heals.

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Posted in Products By Tino Montopoli

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