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Posts tagged ‘Animus’

Taking Animus, Omnipod, and the Dex to Hawaii

The first time we went to Hawaii (and surfed with a tiger shark), Luke was using the Animus. Despite qualms about taking a $5k piece of medical equipment through sand and salt water, we decided to go for it. Animus has a great loaner program, so we got a backup pump before we left, along with a protective film for the display. Still a little hesitant, we tried disconnecting at the beach, so Luke wasn’t the only kid wearing a jet pack on his back. But even with reconnecting to give a basal + correction bolus every hour, blood sugar went high. Pulling him aside to reconnect so frequently was annoying as well, so we swallowed hard, tucked the pump into a pocket on his rash guard, and turned him loose. And you know – it was fine. We did extra checks for sand around the cartridge cap and sets, but we checked the tubing for bubbles every night anyhow.

WP_000296 Ah, the tubing. We were happy to be rid of it when we went to Kauai this year with Luke on the Omnipod. This would be much easier, we assumed. No tubing hanging out the back of Luke’s swimsuit, no bubbles, no sandy sets. We had form factor on our side.
But the pods’ adhesive seemed to dissolve on contact with salt water. Pods barely last half a day, and we were rapidly running through the extras. We tried a tip from other parents: put down a layer of waterproof Tagaderm, put the pod on top, and tape over with extra Tagaderm. No luck – pods still fell off. Under all the Tagaderm, we could see the pod detached and sliding around. I turned to the Facebook hive mind and got more suggestions: vet wrap or Bands for Life, Matisol, Mefix, Opsite, Nexcare waterproof or 3M micropore tape, and Extra Large Waterproof Band Aids.
With just a few days left, we decided to do our usual drill (SkinTac, pod, Tagaderm over the top), with one addition: we wiped SkinTac on top of the pod’s adhesive pad so it was thoroughly soaked and couldn’t take on water. We let it dry (one parent suggested letting each layer dry thoroughly), covered with Tagaderm, and that did the trick! We got a couple days out of each pod (just enough to get us home).

The darling Dex did much better. Its adhesive stayed put the entire week with a little extra Tagaderm, and the G4’s longer range let us leave it in the backpack (we used to carry the 7+ with us in a waterproof bag). We swagged insulin and treats between regular tests, and did ok except for the occasional shave ice or pineapple juice. (A friend coined the term “carbument” after seeing our intense discussion about how many carbs were in a massive puka dog bun. Vacation, people!)
Watch out for military interference, though. We took a catamaran tour along the jaw-dropping Na Pali coast, where we passed a military base that does next-gen Star Wars missile testing and apparently jams equipment that comes into range. Although the Dex was a few inches away from Luke, it lost contact as we passed by the base. A truck with flashing lights drove parallel to our boat – “If you’re taking pictures of them, they’re taking pictures of you!” the captain cheerily announced. DSC02790

If you go to Kauai, wild chickens will be shadowing your every step as well. The 1992 Hurricane Iniki let lose chickens and fighting cocks, and now they are the local answer to city pigeons. As we sat in a drive-through to order chicken McNuggets, we saw a mother hen bedded down with her chicks by the loudspeaker.
“See any irony in this?” Erik asked.
“Don’t let Luke in on the joke,” I said. “Chicken nuggets are way too easy on blood sugar.”

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Ping to Pod – the Good, the Bad, and the Ugly

We’re a couple months into our switch from Animus to Omnipod, and we’re slowly reaching cruising altitude. I’ve gotten great tips and information from other bloggers and podders that have definitely helped the transition – thank you!

A quick snapshot of how this transition looks for a 3-year-old boy and his pancreants (disclaimer: insulin delivery devices are a very individual choice – I’m not out to champion one pump or another for anyone else):

The Good

  • No surprise – going tubeless has been AWESOME! Luke can run around with a pump bumping on his back, we can hug him and not hug his pump, and going swimming is much, much easier.
  • Surprise! – I like that Omnipod doesn’t track IOB for carbs (it does for BG corrections). I understand concerns. We’ve had our share of stomach bugs and mini-glucagon moments, but with bolus history in the Omnipod, we’ve been able to quickly figure out carb IOB when needed.
    95% of the time, not seeing carb IOB has saved us from getting twitchy and giving too many free carbs. And we find corrections work much better without the pump including carbs in the IOB, as Animus does (we are careful not to correct for at least 1 1/2 hours after eating). Animus often would not suggest a correction hours after a big meal even if BGs were in the 200s, because it assumed meal insulin on board would bring blood sugar down – but that often didn’t happen.
  • Complete remote control – Having all pump functionality in one PDM is fantastic, because we change pump settings on an almost daily basis to keep up with Luke’s growing, changing body. The smooth little Pod is safe from his hands, and if he bangs it up or loses it in the pool – no worries about an expensive piece of equipment.

The Bad

  • Freestyle “Lite” vs. Regular strip debacle – Omnipod officially only supports Free Regular strips, but both work in the PDM and our rep told us it didn’t matter. The packaging made it very difficult for Medco to tell the difference, and we ended up with Freestyle Lite strips. A month later, we got a crappy A1C (8.8) that didn’t line up with numbers in the PDM or Dex. I found out from others who’d also had this experience that sometimes Freestyle Lite strips read lower for some individuals. We pulled out the Ping, another Freestyle meter, control solutions, and our fingers, and spent a weekend checking every possible combination of strips, meters, and calibration #s. Turned out Freestyle Lites read 20-30 points lower for Luke, and resetting the calibration to 18 gave a reading closest to the others. We then got a shipment of Regular strips, which we’re now using – curious to see if our next A1C is closer to the PDM and Dex #s.
  • PDM didn’t track correction IOB – Early on, daycare got a PDM error 5, which seemed to be a strip error. An hour later, Luke’s blood sugar dropped rapidly (double arrows down). Our nanny looked at the paper log and figured out that the correction IOB wasn’t being tracked in the PDM. Luke had been bolused twice for a very high BG and had way too much insulin in his system (juice away!). Omnipod replaced the PDM (to their credit, they very readily replace PDMs), gave us a free backup, and reported the error up their management chain. Their manual is very vague about what issues error messages indicate, so we now investigate any error very carefully.
  • Need smaller basal increments – There are a few hours during the day when Luke’s basal needs to be lower than the smallest .05/hour. With Animus, we could set .025/hour or even zero, which is great for small kids. We give free carbs to counter the .05/hour, but it’s one more thing to remember.
  • Limited real estate – Since the Pod is much larger than the average set, it can’t be put in as many places. We can only use Luke’s butt, which is looking pretty chewed up. I’m taking comfort from the fact that other young podders seem to make it work, but – I want the smaller pod this year!

The Ugly

Ain’t nothing ugly about it! Like so many little things, that makes a huge difference. Seeing Luke attached to something that looked and felt like a piece of hospital equipment (with a DOS interface) was depressing. Using a smartphone-like UI and pod feels like we’ve moved into this century, where diabetes is another complicated facet of daily life that can be tracked and managed. In a subtle way, it gives us hope, which is a very big thing.

Ping to Pod

When Luke was diagnosed at 14 months, we chose a pump within days while still in the hospital. I didn’t realize that this was unusual – many people still hear that they need to “master the basics” with shots before going on the pump. We were giving such tiny doses – even with compounded insulin – we could barely see them. Control was a joke, with BGs swinging easily from 40 to 400 (it was the first week after dx, but still…). We chose the pump with the smallest increments, the Animus. Two bonus features: we could bolus from the remote and it was waterproof.
And it has been a great little pump.
Well – not so little. Luke wore it in shirt pockets on his back, and he looked like a Jetsons kid sporting a jet pack. To hug Luke was to hug his pump. “Woah, did I just break something?” my brother-in-law startled after giving Luke a big hug.
Even stripped down to skivvies, our boy looked like a little Marlon Brando in his tight, stained wife-beaters that held the pump.
And there were the bubbles that had us priming every night.
And there were the basal changes that could only be made directly in the pump, often in the middle of the night, which meant rolling him on his side, fumbling under the PJs for the undershirt pocket, pulling out the pump to make edits, and wrestling the pump back into the pocket – without waking the boy.
And he needed his pump while swimming or we’d get highs afterward.
The last straw was that our insurance was soon to scale back, so just before Omnipod’s Cut the Cord program ended on Jan. 1, Luke became a Podder. Thanks to bloggers like Lorraine, Amy, Laura, Joanne, Hallie, Denise, and now Dawn and Stephanie (and older podders – Grace, Q, Stacey, I’m sure I’m missing some), I knew it could be done, limited real estate and all.
We’re just a couple days in, so who knows how this will go – I’ve heard the stories about squealing pods, inexplicable failures, skin rashes, no IOB for carb boluses, and am sure there will be some swearing down the line.
But this evening, whenever I hugged Luke, I felt – his back (the Pod is on his butt). And when he changed into pajamas, all I saw was – his slender back. I half expected to see moss. He walked around with his hand up his back for a while, rubbing absently. “Why the pod that’s all there is?” he asked. “That’s the pump?”
” Yep, bud, that’s all there is,” I said. “Want to keep it for a while?”
(Every time we had talked about the Omnipod with Luke, he had shaken his head and put insisted, “I want to wear the black pump all day and all night!” Don’t know where he gets that distrust of change.)
But he’s keeping an open mind, it seems. ” Yeah, it’s ok,” he said, and snuggled under the covers with a smile.
Fingers crossed…

Surfing with Tiger Sharks and T1D

I’ve always wanted to surf and recently got the chance in Maui. As soon as I managed to stand up and catch a wave, I thought, “Luke’s gotta try this.” Never mind that he’s 3, can’t swim, and had never been to the ocean before that week. He needs to get hooked on things that are pure joy and will make the grind of diabetes worthwhile. This had to be one of them!

And our instructor, M., was the man. 6’6″, incredibly patient, and able to hip-hop on the waves like a kid at a skateboard park, he had learned to surf by riding his dad’s board starting at 2. My ears perked up. “So we have a three-year-old who can’t swim…” I began. “No problem,” he said. “We can start with him sitting on my board – we’ll see what he likes.” (When Captain Cook arrived in Hawaii, he thought the locals were gods, “walking” over the water toward his boat. Had M. been part of that crowd, any women on Cook’s ship would have thrown themselves overboard immediately.)

We were back early the next morning, with grumpy toddler in tow. The logistics were a little challenging: how to take everything we needed for testing and low blood sugar into the water with us? Board shorts, LokSak bags (for BG meter and Dex), “Sugar Shots,” and a box of juice all came together. Board shorts should be standard D-wear: they hold everything! (And look really sexy when loaded up.) Luke wore his pump (BG goes high when he’s in the water, probably due to stress and excitement) and Dex, hopefully heading off the need to test for a couple hours.

M. took Luke on his board, and we headed out.

While Erik and I were shredding the waves…

Luke was having a blast with M. Before long, they went from splashing in the water to Luke riding on M’s shoulders to standing up (with help). The huge grin never left his face.

“We should head in closer to shore,” M. said. “There’s a shark.”

“Shark?” I yelped.

“Shhhhh,” he gestured, looking at surf classes spread out next to us. “Say mano.”

“Uh, so it’s a little one – a reef shark, right?” I asked helpfully, thinking of the small white-tipped reef shark I’d seen the other day whisking away like a cat.

“No, this is a big old one who gets hungry and comes in about once a month to feed on turtles.” Ah hah. The turtles we’d paddled out to watch yesterday – a few hundred yards away. And there we were, a bunch of haole flailing about on surfboards in murkey water while some cranky, near-sighted shark with low blood sugar was squinting about for a snack.  “Catch the next wave in,” he said, “and we’ll meet over by that rock. The other surfers are safe – we should just be extra careful with your little one.” Our little pupu.

I stopped asking questions. Erik later told me it was a tiger shark, longer than our boards (12+ feet).

End of drama, really – but surfing isn’t so different from trying to balance on an ever-shifting tide of carbs, exercise, moods, hormones, and a million other factors. Leaving the hospital with Luke two years ago felt like trying to surf when we could barely dogpaddle. We kept sucking down saltwater, looking out for lurking low blood sugars and unexpected rocky highs, and falling over and over.

But since then we manage occasionally to stand up and ride, and in those moments even the sharks can’t stop us from having a damn fine time.