I got ‘O’level Maths at school; at least I have the certificate to say so. It was 1979 and yes I am that old; I got a grade A too. I got my sciences as well – good grades. I’m also a nurse; one who is supposed to be a lead for informatics but don’t be misled – I’m no nurse geek. That leads me to believe, at least on paper, I’m reasonably competent in that sort of ‘mathy-sciencey’ sort of way.
More recently I wasn’t so sure as my story, this time, is about how very complicated it is to manage diabetes.
A few months ago I decided it was time to be brave and take the plunge; I asked my Diabetes Specialist Nurse (DSN) if I could borrow a Continuous Glucose Monitor (CGM). A significant step, as it allows you to see what your glucose levels are 24 hours a day and helps you to assess whether the basal (base amount) of insulin you are getting via your pump is about right – so far so good. My DSN is a real star; we don’t have CGMs where I get my care so she had to ask for a favour from the rep for me to loan a CGM. I think, (unfortunately – you will see why) she was using me as a ‘test’ patient. I suspect she thought ‘lets see how anniecoops gets on with this’.
In my case the CGM is a small electrical sensor that is inserted into tissues and wirelessly transmits glucose readings to my insulin pump – with me so far? Here is a picture of the exact one and my pump:
I’ve learnt to use the pump well over the last three years and have gradually adopted most of the things it will do and added them in to the management of my diabetes. The pump ‘stuff’ (tubes etc) gets changed around every 3 days and the sensor lasts 6 – still OK? The results from the CGM via the pump can be seen on a computer programme that shows your readings over the period of time that they were taken. In this way you can see what’s been happening over time. A bit of a miracle for me who was brought up with urine testing tablets (but that’s another story).
Ok, so off I go; I have to say having taken the plunge I was vaguely excited! I had an appointment with my DSN and the CGM lady to get going. The transmitter is small but it is VERY dependent on the correct insertion of the sensor. The sensor even has a special ‘insertion device’ like this:
It looks harmless and useful doesn’t it – don’t be fooled! The technique for inserting the device is 16 steps long (I’ve just counted from the manual they gave me). I could go on……. but I feel too traumatised.
What happened over the next two weeks was upsetting as I couldn’t manage to do the inserting myself and being of stoic nature (see my previous blog) I was so determined to go alone and in doing so have wasted 3-4 sensors. Physically inserting the device is really hard as there are so many rules about where it goes and how to do it but essentially I needed to put it somewhere where I could see it to remove the attached transmitter for showers etc. In my experience with my pump your tummy is the best area but my boobs were a major barrier for me to see anything!
The upshot of it all is that I am now waiting for some more sensors and this time I am clear that I can’t do this on my own. Maybe I can over time but I’m going slowly for now.
Hopefully it doesn’t stop here as once I have the results perhaps then I can use my ‘mathy-sciency’ sort of skills, as we will have to interpret the results; make sense of patterns, ratios, timings and hormones. There is also the dreaded ‘dawn phenomenon’ (don’t ask). Perhaps then I will impress the DSN with my skills…..
So, if anyone ever tells you managing diabetes is a piece of cake then punch them on the nose for me. I struggled with the technology and we still have the maths to face, although I really do think I’ll be OK with that…….
If we are going to use all of the devices that are available to help people help themselves then we really do need to think about skills and what sort of help is available. When I couldn’t get the sensor to transmit the most helpful people were the CGM helpline team who were calm and unflappable. My DSN was nearly as under confident as I was – bless her (I guess I was her test patient). If we are going to use all this technology stuff we need to think carefully about how we help patients to understand and be self sufficient, if that’s what they want; I certainly do – it really is very complicated you know!