Don’t be shy

The Shoot Up forums
The modern and advanced Shoot Up forums

Hello you; yes, you! I’m referring to you, dear reader. Are you an avid fan of Shoot Up (and, frankly, who isn’t?) and do you enjoy reading our articles and forums? I hope so.

If you haven’t already, have you considered setting up an account and chipping in with your two-pennethworth in the comments section or on the forums? Shoot Up already has an erudite, well informed and interesting band of regular contributors (well, sometimes they are) and we’d like you to join in with the unending misery too. As well all know, everyone’s diabetes varies, everyone’s experiences are different and so it’s always extremely interesting to hear other people’s points of view on the blog and in the forums.

There are two main ways to join in. If you want you can post anonymously (perhaps you’re an international jewel thief on the run from the law and have to remain undercover). Or you can click the link in the top right corner and create an account. The only thing we need for an account is a unique user name and an email address. We don’t use your email addresses for spamming or dull newsletters. This is mainly because I don’t know how. You can also fill out details about your diabetes and where you come from, but those are entirely optional.

Once you have an account, you can easily post comments at the bottom of articles or start up or join in with discussions over on the forum.

So there you have it, if you’re an avid reader of the blog but have never contributed, now’s you chance to do so. Don’t be shy – go on, you know you want to!

Did the sensor (En)lite up my life?

And so the day has come. I have called an end to 12 days of loyal service from my first Medtronic Enlite CGM sensor. How was it for me? Well…

The much smaller Enlite sensor (attached to the Minilink transmitter)

Overall it was very good. I’ve no real complaints. It seems a good bit of kit that’s an improvement on the old sensors. Not a life changing, swinging from the lampshades, best thing in the world ever improvement, but a good step forward.

Let’s start at the beginning with insertion. This is much improved. It still fires in with a fair amount of force but – I suspect due to the finer, more polished needle – it really doesn’t hurt. It’s still a surprise when it goes in, as it is when anyone fires a bit of metal into your body at speed, but it’s not a painful surprise.  I don’t have the patience to talk you through the whole insertion process, but if you want to see an animated model inserting the Enlite into his beautifully toned, hair free stomach – take a look here, it’s an accurate representation of what I did.

It did feel like 3 hands would have been useful at times as the insertion process and associated stickies were a bit fiddly at times. With the old sensors I was pretty adept at putting them into my back, but I think it’ll be a while before I attempt that with the Enlite, I need to be 100% happy with the process first. I think a bit of practice will sort this out. 

I was a little disappointed that the packaging is bigger than with the previous sensors. In the grand scheme of things, this is a pretty insignificant whinge, but when you’re trying to fit two weeks worth of infusion sets and sensors plus spares in to a bag, it’s a pain. Then every extra centimeter of packaging counts, and they’ve certainly added a few centimeters. I know there are scientists out there who have dedicated decades of their careers to making this wonderful tech, and I also know it’s bigger to accomodate the plastic bit that now hides the previously scary insertion needle, but as a trend, stuff should be getting smaller, not bigger.

The sensor goes in vertically, like a Quickset, which means there’s no more faffing around like there was with the old ones trying to get the exact angle correct, you just whack it in. That’s good. The insertion process felt a bit longer than with the old ones but I think that was because it was new and I wasn’t used to it. A couple more weeks and it’ll be second nature.

The sensors use the same Minilink transmitter, and now come with a sticky bit to secure that to the body. It did seem pretty robust, but I don’t like having any part of the transmitter exposed to catch things on, so I stuck my usual bit of sticky tape over the whole lot anyway.

Once you’re all connected, there’s still the usual 2 hour start up time (although rumour has it this is due to the programming in the Veo pump rather than the sensor, if allowed the sensor would be up and running straight away – I’ve asked for confirmation of that from Medtronic and am awaiting a response). After that 2 hours, it needs calibrating with a blood test. Previously you had to calibrate at that 2 hour point, then again after 6 hours. This one doesn’t require another calibration for 12 hours.

The big question is of course, is it more accurate? The stats say it is. Medtronic reckon its 17% better overall and 26% better when it comes to low blood sugars. That is of course pretty meaningless if you’re a 6 and it says you’re a 10, so in the real world is it actually any better? I’m reluctant to judge it based on one sensor, but yes, it did seem more accurate.

With the old sensors, if they said I was 3.5, I’d usually find I was in the 2’s. When the new one said I was 2.8, I was actually 2.6 so pretty damn close. Equally with highs, it tracked me more accurately all the way up to 16.8 and back again, better than the old sensors. Obviously these extremes of blood sugars were deliberate in order to test the sensor, they in no way reflect insulin/carb errors by the user.

When I had normal control, the readings were more accurate than with the old sensors. The lag between sensor readings and meter readings seems less than the old 20mins. I had very few accuracy issues with the old sensors and had been using them for so long I tended to know when to expect issues, so I wasn’t expecting massive improvements. However, I am impressed in that it does seem more accurate, even for me.  I’d be interested to know what difference the new sensors make for people who struggled with accuracy with the previous sensors.

The Enlite is registered for use for 6 days. On day 6 I turned off the sensor on the pump, disconnected the transmitter, recharged it for 20mins then reconnected to the sensor and started it up again on the pump. It picked up the sensor after the 2 hour warm up, I calibrated it and I was off and running for another 6 days. The sensor was still working perfectly at 12 days, but I pulled it because I don’t like leaving stuff in my body for much longer than that.

Overall, it seems a good step forward with the whole CGM malarkey, of which I am a huge fan.

Happy birthday to Shoot Up, happy birthday to us!

Dimly through the mists of time and clouds of alcohol-induced memory loss I can cast my mind back and just recall that heady day back in 2009 when I published the first article on your soaraway Shoot Up. Uhm, urr, it was on 1st April. Yes, that’s right, Shoot Up is two years old today. So happy birthday us!

I started Shoot Up on 1st April 2009 after becoming jealous of the success of my wife’s blog over at stripykat.com. If she could do it, so could I! So I started off by reviewing blood glucose meters, as at the time no one seemed to give them much thought. My first review of the Wavesense Jazz seemed to go down quite well (sadly the original comments on the post were lost during the Great Database Meltdown of 2010) and so I carried on, moving on to spouting ill-informed and poorly researched rubbish about diabetes.

A chance encounter in the comments section of someone else’s blog led to me meeting my now esteemed co-writer Alison. Alison had toyed with the idea of blogging but didn’t really have technical interest to set one up and I liked the idea of having someone with considerably more experience of diabetes than me writing on the blog. This combination of geekery and experience was a serendipitous one and one that has continued to flourish.

We then encouraged guest bloggers and have been lucky enough to have some brilliant different perspectives from people like Katie, Simon, Annette, Stephen, Samantha, Mark, Shelley, Tom, Sam & Terry, which has added a great deal of value to the blog and given you all a break from our rubbish.

But, of course, the greatest contribution has been from you – our dear readers – without your comments, humour, encouragement and interest (even from you lurkers who read and never comment!) we both would have packed up and given up long ago. Writing nearly 300 articles about type one diabetes ain’t easy but with your help we’ve done it and will, hopefully, continue to do so.

So what have we achieved over the last two years? I hope we’ve been at least slightly entertaining; I hope we’ve approached diabetes in a positive light; I hope we’ve raised a little bit of awareness about living with diabetes (nothing gives me greater pleasure than non-diabetics reading the blog); I hope we’ve encouraged people to question their health care providers.

But one thing I do know for certain is that we’ve definitely created a positive and happy little community on our wee corner of the web and that’s certainly something worth celebrating!

Eye spy a gap in my care

A photo of an eye, if no one else will share them, ShootUp will

Last week I performed my civic duty of attending the hospital diabetic eye clinic in order to reduce the average age of attendees by at least 30 years. There was also a bit of faffing round with my eyes which left me gobsmacked at quite how disjointed diabetes care can be.

My local PCT have a gem of a diabetic eye screening programme. It’s really good. And I’ve told them so. I am harassed by letter once a year to make an appointment with my choice of local optician from an approved list to have my diabetic eye check. Because opticians are businesses they have appointments outside of working hours so I can toddle along for my annual blinding session without having to take time off work.

The optician then does my regular eye test and takes photos of the back of my eye to check for any exploding blood vessels. If no fireworks show up on the photo it is archived and I’m released back into the community for another year. Several years ago a minor eruption was spotted in the far reaches of my eye so I was packed off to the experts at the hospital for them to have a look.

The hospital said it was a tiny blip, nothing to worry about, it was to be expected as I’ve had diabetes since the dark ages and everyone was happy (well not quite, but let’s not go there now).

Last week I was back at the hospital because the latest photos again show some minor fireworks. Following the obligatory let me dilate your pupils until they look like black holes and then shine a very bright light into them until you cry session, the Dr again concluded there was nothing to worry about. Being a nightmare patient I had questions. Were these the same fireworks as last time that are just simmering quietly in the background. Or have they got worse. Or are they brand new explosions on top of the old ones? Would the nice Dr please take me through the images of my eyes over the last few years so I could understand whether overall things were getting better, worse or staying the same.

You’d have thought I’d asked her to eat a live frog whilst dancing naked through A&E. Apparently I don’t need this information, I just need to control my blood sugars. I also need to repair my tongue because I nearly bit it off before I managed a polite response that I have excellent diabetes control, thank you for your concern, but I’d like to understand the long term journey my eyes are taking. Rather than just have a one off meaningless proclamation that everything is fine when there is obviously something there.

Then came the bit that did, for a little while, leave me speechless. The hospital Dr isn’t able to see the images that have been taken by the screening programme. So on the one hand the PCT have more photos of my eyes than I have holiday photos, and on the other the hospital are making clinical decisions about my eyes without the benefit of seeing their full technicoloured history.

I came home and emailed the medical director at the hospital, asking him to have a little think about how we could make diabetic eye care in our area a little more integrated.

I also popped in to see my optician and asked if he could spare a minute to access the image database and talk me through my eye changes over the last 5 years. Following numerous caveats about how he’s not as clever as the hospital Drs and I’m not to take any of this as advice or he’ll be shot, the lovely man did just that. And so I now have the information I wanted in the first place. The initial fireworks have disappeared completely. There are some other fireworks, which are no worse than the original and don’t appear to be getting any worse year on year. Thank you. Now I understand the size and scale of the problem. And I agree, no treatment required. Which means I can focus on trying to introduce primary care to secondary care and getting them to share their toys and play nicely together.

Comatose and rotting toes – the lighter side of insulin dependency