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  1. Patience

    Wednesday, 20 August 2014

    I was stocking a cupboard for work recently whilst we were on a residential. After going in and out of this cupboard a handful of times I grew to hate it with a passion. Well, not the cupboard itself, more specifically the door. It had no handle, and there was something wrong with the closer, so it took about a minute and half at least for the door to close. 

    A colleague of mine who hasn't known me very long stood and watched me go a few rounds with this door before making a very astute observation - 

    You really haven't got much in the way of patience, have you?

    And he would be absolutely right. Patience might be a virtue, but it really isn't mine, unfortunately. What I learned over the past few days though is that using a CGM seems to require a certain amount of patience, not least for me, the patience of waiting for start up day to arrive.

    I was slightly apprehensive when it came to actually inserting the sensor, as I'd read in various places that whilst the sensor itself was comfortable to wear once it was in, the inserter resembled a harpoon and it was quite painful to go in. 

    I was quite intimidated by the inserter when I got a look at it for the first time, and actually, yes it did hurt somewhat going in. It didn't even make my top 20 of 'things that have really hurt', but I believe my words at the time were 'my, that's not particularly pleasant', which probably does rank in the top 20 most stereotypically English reactions to things I've ever had. My experience though was that although I've never had problems inserting pump sites, I found that inserting that putting in the sensor on my abdomen was somewhat tricky having, well...amble breasts which made seeing what I was doing...difficult.

    Hey ho.

    After that initial ouch though, it turns out the sensor is, so far, comfortable to wear. It's not like the limited experience I had with the Medtronic iPro two years ago, where I couldn't sleep because I found it so uncomfortable. To be quite honest, I've barely noticed it's there. Massive thumbs up.

    Watching that blue bar count down to nothing was difficult. Like I said, I have no patience. I couldn't wait to see how this could help me in the time that I had it.  

    One thing I was that the first 24 hours are a real learning curve for the sensor as it learns to interpret what your body was telling it. I was warned - don't over-calibrate and confuse it. Have patience. Yikes. That was a test and a half. I did well to only calibrate it (I think) once more than the recommended amount, because it was at least 5mmol/l (90mg/dl) away from the scores on my meter. But by the time I got to day two, it was pretty much perfectly in line with my meter. 

    I can see why some people would find the constant stream of information overwhelming. I think you need to be the right sort of person to find it helpful. I know I've had to sit on my hands a bit to stop me from jumping the gun and reacting too quickly. I'd been given the advice to not over-correct and trust my IOB. For the most part, it seems to have worked, but when you see two arrows up or down you want to intervene immediately. It's been fascinating to see what different foods are doing to me, and reassuring to see that for the most part I seem to have been doing things right. For the most part. I don't pretend to be all knowing, or getting everything right, or that everything comes easy. That would be wrong and a whole stack of lies.

    Something that I did find confusing was the appearance of this...

    This kept turning up randomly. Particularly, for some reason, any time I walk into the bathroom in my house. Supposedly I need to bring the pump closer to the sensor. I only ever take it off to shower, and I've taken to leaving it on the shelf by the bath then. But one day, these warnings kept turning up all the time. My reaction...

    This, and other questions proves why the DOC is invaluable. I haven't been throwing as many questions out there to the Twitterverse in a good long while. Probably not since I started pumping in 2010 - it's very reassuring to know that people out there will help with all your worries, niggles and ponderings when you're breaking new ground with your D management. No-one was able to actually work out why I was getting so many ANT readings, or why my bathroom appears to be the magical land of no reception. But knowing that people cared was a massive help.

    So it's so far so good. I'm not wanting to confess the depths of my love affair with Dexcom just yet, as I'm not sure I'll be able to cope with the divorce process of when I have to give it up. 

  2. An unexpected (CGM based) party

    Tuesday, 12 August 2014

    I do get some very interesting emails on occasion. Some of which come with offers or invitations to various events or interviews. The problem comes when I have to reply and say 'thank you, but I can't'. These are frustrating enough when I get invites that are based in the UK - they're almost always based in London and being as I have a limited income and don't drive, I've always had to turn them down. Frustrating, like I say. But from time to time, I get emails asking if I'll be at this conference, or that conference - always based in the States - and would I like to meet this person, sit in something else. Nothing that I'm certain umpteen far more prolific bloggers than myself don't also receive. My response is always the same - 'Thank you, but I live in the UK and do not have the finances to attend. If an opportunity ever presents itself when they might be in the UK, please let me know.'. Best wishes, hit send. That's usually the last I hear of it and understandably so! But imagine my surprise and my pleasure when a swift reply entered my inbox - 

    'Would you be interested in a telephone interview instead?'

    Why yes. Yes I would! What a great solution! The lovely communications representative and I sent a few more emails back and forth and played some time-zone maths, and set it up.

    Which is how I found myself speaking to Terrance Gregg - the current CEO of Dexcom

    First off, I'll say that it wasn't something I ever thought I would have the opportunity to do, especially away from the ADA conference which was originally the time slot where he would be available. I was very aware of the sort of schedule he must keep and I was very impressed that he was willing to take the time out to talk to me when I was halfway around the world.

    I was struck by how much of a gentleman he was - mostly because he was very patient with me. Honestly, I was nervous and I ramble when I'm nervous. I usually make a point of telling people this, and making them know they're free to cut me off - I'm liable to keep on talking indefinitely otherwise! 

    We talked a lot about the future of Dexcom and CGMs in general in the UK - as I'm sure anyone who is reading this is aware, the differences in healthcare systems in the US and the UK are quite vast, and it is extremely difficult to get NHS approval for a CGM, with self funding being the only avenue for the majority. 

    'Reimbursement landscapes are daunting.' I wrote down as we talked. That's not particularly surprising. We covered some familiar ground for me as we discussed the need for devices, particularly in the UK have to demonstrate a high level of cost effectiveness in order to gain wide-spread approval. 

    Within the NHS that makes perfect sense. When you're funding the many, you've got to make hard choices and something like CGM technology has to prove that it can be effective and cost efficient to make it accessible to more patients. It makes sense, like I say. But when you're waiting for that time when the tech will be more easily available, you can potentially get a bit impatient. I like to temper hope and optimism with facts and realism. What was extremely encouraging was talk of recently received reimbursement in Sweden and Slovenia and that a dossier is currently being prepared for the UK. I wrote down a particular quote - 'the landscape is changing.' - which I think balances things in a way that I favour. Yes the landscape is daunting, but it is also changing. In order to make progress, there's a lot of work that has to be done. 

    I was also encouraged by the attitude to patient engagement that came across from our discussion. I felt a real sense of belief in the importance of talking to your users and listening to what they have to say. I personally don't think a company stands a long term chance unless they do - if a company isn't listening to my interests, then why should I want to use or continue to use their product or service? But I felt not only the sense of importance but a sense of pride in user engagement. If they're proud of that, then I think they can be proud of themselves. At least in my opinion, for what that's worth. 

    We left the conversation with my saying that, for the UK at least, my door, or phone/inbox was always open - I think they have a great products, from what I know of them from reviews, blogs, and all the ways I've come across them. I think they have the right attitude - a plan and long term strategy. 

    However, in the style of a late night JML infomercial for fountain pens that will stab through tin cans....

    But wait, there's more!

    I had a clinic appointment not long after this conversation. Admittedly, I'd been dreading it, but it turned out a million times better than I had anticipated. A HbA1c of 6.9! Almost certainly influenced by hypos, but I'll still take it. No complaints about my weight! Hoorah! But somehow we strayed on to talking about my speaking to Terrence Gregg, and this is where the discussion went - 

    Would I like to do a Dexcom trial, since I already used an Animas Vibe?

    After wondering if I was having my leg pulled, I managed to respond with a 'Yes. Yes I would.'. Would I like to? Getting the ability to switch on the Vibe's CGM function was, as I have put it several times to different people, a bit like having someone offer me the Holy Grail. Something I thought would never happen - magical and unattainable. If I can't afford a few train tickets to London to take up some of the interview offers I've had, then self-funding sensors was never going to happen. So we put a date in the diary. Turns out that Animas had some funding to run some trials. Everyone knew full well I wouldn't be able to carry on afterwards, but they would let me do it all the same. 

    That date in the diary was today.

    I was tremendously excited about the whole thing, up to a point where I apparently surprised the Animas training staff. And she's met me before. Several times. You think she'd have known better. So I'll be blogging about how I'm getting on with this trial. Right now I'm having a bit of a weird day with it, but I'm told that is completely to be expected with a new sensor. General wisdom seems to be that it takes a good 24 hours to learn what you're like. I know that's personifying it slightly, but it seems right.