Dexcom G4 Sensor Number 6

Gone are the days when not many people knew anything about diabetes. Unfortunately, too many people now know what it is, but what they know is often wrong. We could play the blame-game here, but I’ll desist. Some people who should know better, don’t do much for the cause. Such is the diabetes climate at the moment.

What we need in the diabetes world is a cure. What we need is more funding for research. At the other end of the scale, we need funds to provide insulin to those who can’t afford it. In the developing world, there is a huge number of people who can’t afford their insulin. Sadly, in the West, numbers are also going up with people losing jobs and therefore, particularly in the USA, their insurance. There are programs in the USA for people in these situations, but by comparison, few programs in developing nations. Spare a thought for those less fortunate: www.insulinforlife.org.

I started this post ages ago. Where does the time go? I have no idea!

Get up, work, eat, work some more, take care of household stuff, then it’s time for bed. One day runs into the next. This has been the treadmill of my life lately. Not that I’m complaining, but living Ground Hog Day at this stage of my life, isn’t what I envision for myself. Then again, it means there are no dramas, and diabetes management is trundling along ok.

Not that there haven’t been challenges. Two weeks of highs, for no obvious reason, then another two weeks of lows all over the place. Much as I seek to rationalise, sometimes the reasons for this happening is beyond my reach. Best one can do is roll with the punches.

Two days ago, I inserted Dexcom G4 Sensor Number 6. I had an initial box of 4 with purchase of the G4, plus a bonus one. Then by way of a miracle, I got another sensor when my insulin pump was due for its 4 year hiatus. I got a new Vibe. I’d already had a Vibe since January as a temporary replacement when the Animas 2020 went through a recall (mine was working fine). So there was Sensor Number 6 – my last sensor.

Only 6 sensors since January? It’s the end of June!! Goes to show you how long they last me! I must be incredibly lucky!! I’m not even going to tell you how long the last one was stuck to me and working just fine. It was an obscene amount of time. I took it off for a number of reasons, but when it came off I had absolutely no issues. No redness, no gaping hole, no nothing. Two days later, I can barely see where it was.

When I have a sensor in that long, I don’t just rip it off. I take it off very gently and make sure when I start taking it off, the sensor wire comes off with it. I take it off in the direction that the sensor would come out.

The sensor came out fine. The biggest problem is that the sticky stuff doesn’t last, but I use Fixumull Stretch to keep it stuck down. And I ALWAYS clean the area thoroughly with an alcohol wipe before I put more tape on. I use the tape from about day 4 or 5 onwards. That way the sticky on the sensor doesn’t get a chance to start lifting and getting dirt or harmful germs under it. I’m not a germ-phobe by any stretch. This is just common sense, in my view.

Life with Celiac is getting easier for me. After 8 months, I think I’ve done a stellar job in healing my gut. Many people are dairy intolerant when first diagnosed with Celiac. I was no exception. They say 6 months to 2 years and you might be able to eat dairy again. I’m eating hard cheese and yoghurt now. For only the second time since November, I had a decaf latte with regular milk the other dat and have had absolutely no problems. Yay!! Huge change from 6 months ago!

I don’t tend to buy a lot of gluten-free products off the shelves. They are so full of rubbish! I don’t eat many legumes, they can be a problem too. It’s not all that difficult to eat fresh food. As humans, we’ve done it for thousands of years. But in the last 50 years or so, packaged and processed food has crept increasingly into our diets.

I was just saying to a friend… where were all the allergies and food intolerances 50 years ago when we were kids? Now every third kid and adult has some kid of problem with food, and as many don’t know that what they’re eating is a problem. Sad really.

So yes, there are recipes I miss, but my lovely dietician told me not to think I couldn’t have something until I’ve tried to figure out a gluten-free alternative. One thing in particular, which I’ve eaten all my life, was Wiener Schnitzel. I resisted buying gluten free breadcrumbs for ages, but a few weeks ago I gave it a go, with some gluten free flour used in the three-step breading process. I was pleasantly surprised. Ok, not quite as good as the original, but very passable. Yes, not particularly low carb, but wonderful nevertheless. I’m feeling a whole lot better about this gluten free thing. I’m even making my own raw cacao, raw nut fudge (tweaking the recipe all the time). It’s made wiwth coconut oil and raw cacao butter as well, so the taste is awesome. It’s also a really slow burn so it hardly moves the blood glucose for a small slice! Now that’s a treat I probably never would have discovered if it weren’t for my original diary issues.

Popping in to Burleigh Markets on a Saturday means I can bring home a huge variety of seasonal, farm-fresh vegetables. They are so much better than the sprayed supermarket veggies!

Can’t be bad when you know you’re eating mostly fresh food with nothing added except the seasonings you choose.

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How Accurate Is Your HbA1c?

Anyone else think their HbA1C doesn’t match their glucose averages?

Even if you test 10 times a day on a regular blood glucose meter, there are not enough measurements to make a case that your measured HbA1C might be wrong.

I now have 22,074 Dexcom G4 CGM readings over the last 3 months, and it’s been pretty accurate against my meter. That’s one measurement every 5 minutes!

My CGM average for that time, according to the upload at Diasend, is 6.7 mmol/L. That tells me I should have an A1c of around 5.8% or 5.9%, at worst, 6%, if I’m being conservative.

I just wanted one single A1C under 6% in my life to prove I could do it with only a couple of mild hypos a week, if that! But that’s another story.

So what comes back today from QML labs? HbA1C is 6.2%!

That’s quite a difference, don’t you think?

In the past I’ve had high haemoglobin and my endo would adjust my A1C down, but my haemoglobin was getting better and within normal range. I’m now kicking myself that I didn’t get haemoglobin tested at the same time. Still, what a difference!

So now I have to ask… how accurate is the A1C test? How different is the result between different labs?

There are lots of sites to convert average blood glucose to A1C, like here: http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html … look further down that web page for the conversion from average blood glucose in mmol/L to HbA1C.

That site says my HbA1C would be 5.8%. So why was the lab result so much higher?

How interesting… look at the post by sugar2 here:http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=15&t=20432. She says that she got an A1C at two different labs on the same day, two hours apart, and they came out different – 7.4 and 7.1. Maybe I’ve answered my own question. Labs really are different.

My standard deviation isn’t much over the three months, so it shouldn’t make much difference. Besides I have thousands of CGM readings. I seem to recall reading something about people being high or low glycators and that can make a difference to A1C.

There you go… found the research:

High and low hemoglobin glycation phenotypes in type 1 diabetes: a challenge for interpretation of glycemic control:  http://www.ncbi.nlm.nih.gov/pubmed/12200073

“…29% of the patients had HbA1c levels that were statistically significantly higher or lower than predicted by the regression equation. The observed individual differences in the relationship between MBG [MBG = mean blood glucose] and HbA1c were not related to erythrocyte age and there was no evidence of analytical artefact. We interpret these results as possible evidence of high and low haemoglobin glycation phenotypes within the population. We conclude that MBG and HbA1c are not necessarily interchangeable estimates of glycemic control and that haemoglobin glycation phenotype may be important for the clinical assessment of diabetic patients.” (Spelling corrected for UK/Australia.)

From what I can tell, high haemoglobin wasn’t an issue in the research, where I assume people had normal haemoglobin. It was more a phenotype distinction, or rather conclusion.

I’ve heard the terms “high glycator” and “low glycator” bandied about, but I wasn’t aware that it was because of phenotype rather than higher than normal haemoglobin values, which if high, would add to the inaccuracy, according to my endo and others.

I’m going to assume that I’m a high glycator, considering the differences between the lab result and the calculated result.

That would mean, if the research paper above was correct, that 29% of us don’t get an accurate A1C! Freaky considering our lives are judged by it.

Think about it! If someone was tested and got an HbA1C of 7.4%, their diabetes team would tell them they have to improve to get under 7%. Yet if they wore a CGM like me, and had tens of thousands of measurements and they were really 6.8%, they’d be congratulated on a great HbA1C.

HbA1C results seem to be taken as fact, when indeed there are extenuating circumstances that can’t be seen. At the other end of the scale, Anaemia will make your HbA1C lower, and so will being a low glycator, which is genetic. Blood disorders that have an effect on haemoglobin do matter, and so does your glycation phenotype.

I’ll take the average between the lab measurement and the A1C/CGM average worked out by formula. Far as I’m concerned I got my A1C under 6… I’ll even take a 5.9999%. I reckon that’s fair, don’t you?

(I welcome any corrections to the conclusions I’ve come to in this post. I’m not a doctor and there are others far more qualified to more properly interpret.)
 

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Technology and A1C

Despite being mostly low-carb before, I’ve lost about 7 kg since November, essentially without trying… more by default.

For the weight loss, all I’ve done is gone gluten free (and not buying much gluten-free processed stuff) and mostly dairy free (although I can eat some hard cheese now).

I eat about 80-90% fresh, mostly raw food, and I’ve still had some sweet stuff here and there – bliss balls and raw-food “cakes”. I also eat meat, fish and eggs, the odd piece of gluten-free, low-carb bread or corn crackers, and I don’t worry about fat unless it’s hydrogenated, which I stay away from as much as possible. All other fats are fair game.

My total average carb intake per day (68 grams/day), over 3 months, is just a few grams less than it was at the same time last year, and I couldn’t lose an ounce for the last 20 years!

The real kicker, and one point point of this post, is that my A1c, a 3 month “blood glucose” average, has come down even more since back in February when I was 6.3%. I thought that was pretty darn good with only 1 month on a CGM. Going by my Dexcom G4 CGM averages to now, I’m amazed!

I’d like to show you something – just one box of a 90 day compilation of what having a CGM since January has done for me…

cgm_avgIf you look at the CGM Average of 6.7 mmol/L (121 mg.dl) with 21,776 readings over 90 days, it’s a good indication of what my A1C would be – something under 6%.

There’s been some discussion about A1Cs on an international Facebook diabetes group for people with LADA Type 1 Diabetes. Lots of endocrinologists don’t like Type 1s to go under 6%. While my endo would disagree that under 6.5% is better than between 6.5% and 7% in terms of reducing long-term complications, I’ve read studies that say it definitely is better. I’ve read that the risk of microvascular complications begins to increase at an A1C level of 6.5% as do other complications.

Look at this chart from http://www.a1cnow.com/asset/images/chart-professional-about-a1c-risk.aspx.

chart-professional-about-a1c-risk

While this chart seems to show not a heap of difference between 6% and 7%, there’s still some difference. I also don’t know how old that chart is or where the data has come from. Other research I’ve read makes a bigger deal of the under 6.5% thing.

The issue is how, with Type 1 Diabetes, one gets to under 6.5%. And please note that I’m only talking about adults, not kids. There seems to be a general assumption with some diabetes professionals that you can only get under 6% or even under 6.5.% by having lots of hypos – and that can not only undesirable, but if low enough, can be dangerous. Agreed!

Much as Bernstein and his diet was my saviour from DKA many years ago, I don’t have to, and don’t want to restrict myself to 30g of carbs per day. But the question he poses is still valid – why can’t people with diabetes have normal or near normal A1Cs? I’ll settle for more normal than “under 7%”.

There was a long time many of us couldn’t achieve good A1Cs unless we were either creatures of habit, eating the same thing every day and adjusting insulin doses and timing until we got it exactly right, or eating very low carb per Bernstein, and/or doing tons of exercise. And I’m sure others got there by doing other things. But the lows usually lurked and hit the lower the A1C.

Worse is that if you are hypo-unaware (don’t feel any symptoms of being low) they hang around until you test, and the danger is you can keep going lower. Everyone has a different threshold at which they start to feel they are going low. For me it’s not until I get to 3.2 mmol/L (58 mg/dl) – well into a hypo.

We now have some fantastic tools available to treat diabetes – more and more sophisticated insulin pumps and ever more accurate CGMs without any lag. Unfortunately, they’re still expensive, and out of the reach of many. I’m all for being a socialist in this respect. Health shouldn’t be just for those who can afford it. Governments and Australian Private Health Insurers (PHIs), take note!. Yes, I’m a dreamer!

Dr Michio Kaku, a Theoretical Physicist, has a published a book called: Physics of the Future: How Science Will Shape Human destiny and Our Daily Lives by the Year 2100. Yes, it’s a mouthful and as interesting as it sounds to read (well, to me anyway)! I think he’s a much better writer than a speaker, but I digress.

Dr Kaku proposes that microchips are slowly moving towards costing a penny each to produce. That in itself, will revolutionise the way we live. By default, I propose it will also revolutionise the technology we use to manage diabetes. It’s driven by microchips and clever programming. The more affordable the technology, the more people will buy it, and then it becomes even more affordable, while also becoming not only more sophisticated, but smaller.

Drug companies producing exogenous insulin also need to keep up by producing insulins that have a more effective action and faster onset.

I’m assuming that by 2100, we’ll have a cure for diabetes – maybe not in my lifetime, but there’s always hope for the future. In the meantime, I’d like to be the poster child for how much the Dexcom G4 CGM has helped to bring my A1C down. It’s probably further down than my endo would like, but I’d like to remind him that I currently have the tools at my disposal like never before, to very safely bring my A1C further down than I could ever get it without these tools. And it’s possible without lots of lows, and definitely nothing even approaching a ‘dangerous’ low. In fact, I only have a couple of very mild lows a week (often with unexpected activity), and in 90 days, only 1 low below 3 mmol/L, at 2.4 mmol/L, when I missed the first two alarms/pump vibration alerts because I was active and in a noisy place.

It’s so much safer and easier these days for people with Type 1 Diabetes to have an A1C under 6.5%, and even under 6% if you so desire (and still have a life), if you have the right tools and know how to use them to your advantage. And yes, I’m still learning! It’s even easier for people to have an “approved” A1C between 6.5 & 7% with these tools – all with no dangerous lows because a CGM will warn you the moment you go under your safe-limit, and you can take action right away.

 

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Animas Insulin Pump

I've had an Animas Insulin Pump since June 2009. I absolutely love my pump and I love the wonderful people at Animas (AMSL Australia).

If you are even remotely thinking of getting an insulin pump, please feel free to contact me and ask me why I love mine and what a huge difference it's made to my life.

There are also lots of posts here to give you similar information.