Ouch

Bjorgflur Gudmundsson. You've probably never heard of the guy... I only heard the name before because I happen to follow british football and he's owned West Ham for a while.

Look, I don't care he was indicted on embezzlement 20 odd years ago. He was worth over a billion dollars at the beginning of 2008. Reportedly, his entire net worth was wiped out in the collapse of Iceland's economy this summer. All of it.

I can't help but feel for him. I cannot imagine what it must be like. From billionaire to bum in 6 months.

Ouch.

Drugs are fun

So I screwed my back really bad Friday... been in bed more or less throughout the weekend, finally got back on very wobbly feet today. I had gotten somewhat used to the pain, but it was constant and rather debilitating. I thought it was a pinched nerve, but my doctor today figured it was that my left SIG joint got out of whack, which explains why I've been standing funny.

Anyway, he put me on some pretty strong drugs - Voltaren for the inflammation, Skelaxin for the muscle spasms, and Percocet for the pain. Wowza. Talk about a powerful cocktail. I can still feel everything, and a dull ache every time I move right where previously it would have been a sharp pain followed by a few seconds of throbbing pain from the spasms.

Who said drugs can't be fun?

Nav vs Dex leading to... Onetouch vs Freestyle

OK, so this is weird.

I would never have seen this otherwise, but last year when I got the Dex I was also forced to switch my meters from the Freestyle Flash to the One Touch Ultra (because the Dex would only calibrate on the latter).

Then I got the software update for the Dex that would allow me to use any meter, but I had a bunch of left over strips for the OT so I kept using that for calibration, eventually aiming to switch to the much more user friendly Freestyle.

However, when you're wearing a real time monitor, strip use is very much lowered. I used to prick my fingers 12-15 times a day; with the Dex it was 4 or so, with the Nav even less (because it does not require the mandatory 2 calibrations a day, plus it seems more accurate overall). So I'm still using the OT for non-calibrations, and the built-in Freestyle in the Nav for calibrations.

But I've been running a little low recently - back injury put me in complete bed rest for 3 days, no appetite, very little food - and I had the occasion to use both finger meters at once so validate the Nav. I've never done this before.

Here is something odd. The One Touch consistently gives lower results than the Freestyle, and obviously the Nav (which calibrates off the FS). I just did this - Nav was showing 113, Freestyle 103, and One Touch... 67. It didn't feel like I was hypoing, but now I'm a little confused. This is not the first time either. So just how accurate are those finger stick meters? which one do I believe?

Well, actually, I suspect I know the answer to this one. One thing that has bothered me significantly since I started on the Dex was that my A1C's were consistenly higher than what the Dex and the One Touch indicated they should have been. I ran some analysis and the difference was consistent, at between 0.3% - 0.5%. Say I came into the doctor's office expecting an A1C of 6.7-6.8 (based on the results from the CGM and the overall average on the OT), and it would come out at 7.1 - 7.3. Even taking into account the depreciating effect of blood sugars on A1C numbers - that is, that more recent results count for more than older ones - it still didn't correlate. This was a major annoyance for me because over many years, my meter average usually ended up close to the A1C, due to testing so often through the day. It would occasionally not work but I would know that in advance, because I would have had a major overall change in blood sugars in the week or two before the A1C test (say, due to rapid weather changes).

But now I can venture a different guess - that the OT was reporting lower numbers than reality, consistently. That's a little scary come to think of it. How would anybody know? I don't know of anyone who actually runs a control solution test on a regular basis; I never needed one, and my meters have always seemed fine and tracked well to A1C's. The next few months will shed much more light on this, but it seems like I may have been led astray by the OT meter.

Confusing, to say the least.

Yet more on the Nav vs Dex

1) Did I mention I love the arrow? however, caution is necessary here; all the arrow does is provide a current rate of change indication. This can be misleading when you are just about to peak, whether it is from food or from insulin. When that happens, the arrow can shift very quickly, and the predictive alarm can be completely useless.
1a) I would not use the predictive alarm on the 30 minute setting. Too much can shift in such a large time gap.

2) The transmitter IS big. Now, this isn't a problem during the day, but if you wear this sucker on your arm, and you like to sleep on your side... just make sure you can sleep on either side, because I guarantee you, you will not be sleeping on the side that has the transmitter in. Or you might, and wake up with a nice bruise sitting right under it.

3) The range is impressive. I've seen the signal stay on at 30 feet through two walls and a floor/ceiling.

4) The accuracy is better on the Nav. At this point I am going to say that from my one week experience with it, I am far more likely to trust it than I ever did the Dex. Where this really comes into play is when I'm resting or sleeping, when the interstitial fluid gets "pulled back". For some reason, whereas the Dex readings become less reliable at those crucial (sleeping) times, the Nav manages to continue on merrily with the same level of accuracy as while fully awake. That is rather critical.

5) I think there is also something to do with the Ultratouch used to calibrate the Dex vs the built in Freestyle Flash that comes with the Nav. I have now used both for a while as part of my comparisons, and have found that the UT consistently displayes lower blood sugars than the Freestyle. The gap can be quite big, 30-40 points. Thing is, the Nav seems a lot happier with calibration results than the Dex ever was (I used to almost always get "???" following calibrations, as if the Dex didn't like them), leading me to believe that my UT may be "off". This would (finally!) explain why my A1c's for the past year never seemed to reflect the Dex averages - they always looked like I had higher averages. If the UT was skewing low, then so would the Dex, compared to reality.

6) I think I found a way to "reset" the transmitter after the 5-day sensor expiration without needed to remove and reattach it. It's simple: go to the menu, choose system, then status, then removed sensor. Approve that, then wait for a minute. The system will then pop up a question asking you if you inserted a new sensor. Confirm and it starts a new cycle. Never had to touch the transmitted to do that.

More on Dexcom vs. Navigator

Spent the whole day yesterday with both devices... my Dex sensor ran out last night so it's off me for now.

First of all, the number one thing that yesterday did was make me realize just how much I came to absolutely hate the the question marks on the Dex. I am referring to the "???" entry when the Dex isn't sure if the sampling is reliable. In fact, I had so much quiet resentment built around this feature that it all came out in a huge rush of relief throughout the day, because with the Nav, there is no such thing - you always get a number.

The Nav also seems more accurate in many instances, although the Dex seems more likely to catch falling blood sugars faster. That is, on a downtrend, the Dex is more likely to be closer to fingerstick readings than the Nav. Now, I'm not entirely sure if this really matters, since fingerstick readings are themselves not exactly what matters to your body ("cell starvation" does). The Nav deals with this issue with the arrow.

The arrow really is a rather neat feature, and it saved me from a major swing yesterday after lunch. I was looking at the Dex and could swear that I was going to hypo when my blood sugars were around 110 or so. The graph on the Dex was a bit misleading in showing a downtrend, and a fingerstick of course at that point adds no new information (it showed 110 too, woopity-hey). The Nav, however, showed that I was stable with the arrow pointing right. I decided I'd follow the Nav's data rather than what my body was saying and what the Dex graph seemed to indicate, and instead of pre-treating a hypo, just hedged my bets, ate about 5 grams of carb and waited.

The reason I try to pre-treat hypos is because I fall so fast when I do; like I showed a while ago, I easily drop 100 points or even more in 15 minutes. Since it takes 10 minutes or so for the body to start absorbing even the fastest acting carbs, when I sense a fall coming, I have to treat even if I may be at 140 at the time. Usually this works well and I "catch" the hypo before it happens (eating 30g of carb at 140 to, say, stabilize at 120 a bit later, dropping no lower than 90), but sometimes, due to other factors, my body sends me signals that are very similar but in fact have nothing to do with blood sugars, and it can be very confusing.

Well, lo and behold, the damn Nav was right. I dropped to 103, then slowly rose to 117. This was confirmed with fingersticks. The Dex graph also stabilized, so in retrospect everything was fine, but because I had been steadily and slowly dropping beforehand, I would have previously loaded on carbs and ended up in the 200's.

The point is that the rate-of-change arrow made the determination between "I'm just tired, stressed and a bit a hungry from the cold" and "I'm about to drop into the 30's in 20 minutes" that little bit easier... and it was correct. I'm going to focus a lot of attention on the little arrow in the coming weeks because it seems rather ingenious if it really is reliable.

Another point that was made over and over yesterday - the Nav is eons better when it comes to range. With the Dex, I have to carry the thing all the time - not only on my body, but on the right side of my body (the side where the transmitter is), otherwise it misses readings ("Y" indicator). I mean, it has become a habit for me to allocate a certain pocket on my person to the Dex depending on which upper arm I stuck the sensor.

With the Nav, I could just as easily leave it on my desk and go into a nearby office and come back a bit later to see it was happily registering the signal. I am going to play with this a bit to see how far it goes, but it most certainly goes farther than the 5 feet or less the Dex gives me normally. At night this is even more crucial because the Dex detests the idea of sleeping on the transmitter and loses connection, whereas the Nav seems to not care whatsoever. In fact, it seems like I might be able to place the Nav receiver on the nightstand rather than next to my head at night, something I could never do with the Dex. I'll try that next.

With that said, the Nav alarms, with all their variety, can't do one simple thing: give me both a noise and a buzz on a high bloodsuagr at night, then just shut the frick up after I acknowledge it. It takes a couple hours for bloodsuagrs to start coming down after a bolus shot, and the damn thing will only allow me to mute it for 1 hour, and even that requires quite a bit of menu-driven operation at 3AM. Why not just let me say "OK, got it, dealt with it, now shut up till the morning"?

The alarm isn't as loud as the Dex, either. That's not so good for nighttime warnings. May have to keep it near my head anyway.

New CGM

This is rather awkward, but I am currently wearing not one, but two continuous blood sugar monitoring systems on my body... the Dex on the right, the Navigator on the left.

The trainer for the Nav came in today and we went through the procedure. The Nav is definitely more finicky than the Dex in terms of dealing with the insertion itself; the idea of having to wait to blot out the blood for example. But the insertion device is much easier to handle one handed than with the Dex, a necessity when using upper back arm locations. It also hurts quite a bit less to put it in.

My main complaint about the whole sensor business is that Abbott doesn't trust the stickiness of the tape to the degree that they add an additional overlay bandage with the sensors. However, the overlay isn't precut to fit the transmitted, meaning that you have to actually mark and cut it yourself. That's sloppy. Really no excuse for that. Plus I don't understand how come Dexcom can make a sticky that works just fine and dandy for the entire 7 day duration whereas Abbott can't even be sure enough that it will hold for 5.

I like the Nav receiver better than the Dex - it feels smaller, although I am not sure if it really is in practice. I really like its shape and the silicone cover. I also like all the little features that are built in, like the reports. I haven't experienced the predictive alarms yet, but they promise to be an exciting feature, I am looking forward to seeing them in action.

I love, love, love the battery operated devices. Why Dexcom chose the ipod model is beyond me. The idea that I have to buy a whole new system every year is a little irritating, to say the least, although I do get the benefit of having the most recent at any given time. With that said, I much prefer Abbott's approach of allowing me to replace batteries for as long as I want, without the constant fear that one day one of these devices will die unexpectedly and I won't have access to the system until I shell out several hundred dollars and wait several days for a new one. I must also note that my Dexcom transmitter signal has weakened noticeably in the past 3 months, probably indicating nearing its end of life, but it hurts performance. Won't happen with the Nav, and that's a good thing.

Of course, the big hit against the Nav is the 10 hour delay from insertion to calibration. I understand it's because Abbott prefers not to show results that are not very confident; honestly, I don't think they should be the judges of that. Dexcom allows you to see results within 2 hours even though the first day is always a little less reliable, just as I presume it would be with the Nav. By the same token, Dexcom won't let you see results it doesn't trust even if you wanted them, with their "only see last number" and "???" paradigm.

I don't really understand this paradigm; just give me the data, and let me manage my disease. I know better than all of you what my body does and how it reacts and how it behaves and when to trust a reading. It's rather annoying to have to deal with some engineer's generalized view of what "should be" when they have absolutely no clue as to what reality is when it comes to my own body. Both companies are at blame for this, in different ways.

Zero percent financing... at a very large scale

Look, I'm one of the few who think the US is not doing as badly as many think.

But even I am surprised at this one. On Tuesday, the US government sold $32 Billion dollars worth of treasury bills. The interest paid on them? you guessed it. A big fat zero percent.

In other words, the people buying these bills were effectively stuffing money under the mattress to the tune of thirty two billion. The US government - which means you and me, folks - in the meantime, got a screaming deal. Yes, they are short-term (4 weeks). But still. In fact, if I am getting the story correctly, some of the 3-month T-bills were trading at BELOW zero interest. In other words, investors were paying a tiny amount for the pleasure of having them.

Nuts.

And on another front, I got a piece of really good news today. My insurance company has agreed to cover a new Abbott Navigator. It means I'll have to drop the Dexcom I loved so much, but on the flip side, I get to no longer pay all of these expenses out of pocket, and that's big savings. I should be getting it early next week, and be wearing it by Thursday. I'll let you know what I feel about the difference between the two devices.

Why I haven't posted

OK, folks, sorry. So much going on it's tough to catch a breath and write. My travel schedule is insane; 4 days in Dallas a week ago, flying out to Israel in a couple of days, coming back a week later then flying to Alaska (in December!) two days after that. I think by the time I'm done I'll have developed a deep hatred for airplanes.

In addition, I find myself spending my spare time cultivating new relationships following our switch to a poly life style (our marriage now being open). I'll say this: when I was simply trying to recover from the shock of transition, I wrote a lot of material that took quite a bit of time to put down. As the shock wore off and I raised my head and started looking at the world with fresh eyes, the world just winked back and, well, responded. In fact, one of the things that is happening right now is that I have compiled a manuscript based on the largish volume of private writings from the last few month, and am having a discussion soon with a publisher about potentially using them as a foundation for a book.

More on that following progress on the matter.

a couple notes:

1) jealousy is not something set in stone, and it is certainly possible to overcome. Believe me, I had gone through the absolute worst of it, and emerged whole and better than before. In fact, I now count overcoming the green eyed monster as one of the most important personal growth factors I have ever experienced.

2) the poly community is making a grave but understandable error in its quest to gain acceptance. There have been quite a few recent books on the topic, but they all suffer from the same malady poly folks seem to exhibit when speaking to the mono world: saccharinity. All these books read like some sort of promotional campaign, focused as they are on the educational concepts of poly, and what it means to live in an open relationship. Nobody really discusses the ugly side, and the end result is unfortunate; you can't really get any sense of the million ways this hits you painfully in the gut when you try it out. Even worse, the community almost seems preternaturally inclined to become extremely defensive to any show of perceived negativity about the life style. Thing is, this makes folks less likely to want to discuss the matter... not more. They instinctively grasp that something in the communications is not kosher.

That is why I have compiled the manuscript. My book will reflect the emotional rollercoaster of my own journey from someone living more or less happily in a completely traditional marriage, through someone living with a wife who has chosen another lover, to someone living in an open marriage that is stronger, more realistic, and far more mature than the one he had before the transition. And believe me, some of the stuff I was going through was ugly. It will be highly intimate, very raw, filled with corrosive, poisenous and destructive thoughts and emotions and feelings, just as it will be filled with elation and acceptance and growth and understanding. At times I felt like I was developing a split personality, becoming bi-polar, maybe schizophrenic, as I was walking through the parallel paths of pain and learning. But as is always the case, the most valuable knowledge only comes from the greatest effort (somebody must have said it before, but if not, there you go, an old chinese proverb of my own invention). I have let a limited number of people, from different walks of life, sample it and they have all found many things to relate to in their own lives. It's a very personal journey and it will serve not as a manual, but as a shared experience, and one that, at its worst, was rather frightening. My point is that, like in anything else, switching to this paradigm has both its good and bad sides, and it should not be taken lightly. Nobody else really speaks about the bad stuff!

3) at the end of the day, foundational poly concepts are solid. The most important one: you CAN love multiple significant others, with no diminished capacity for loving any of them individually. I didn't believe it until it happened to me. But when it does - when it truly happens - it is mind blowing in its obviousness and simplicity. Of course, the challenge is that the people you love may not be open to, may be threatened by being loved non-exclusively. THAT conflict is not easy to resolve. But when they do... oh my.

Anyhow, with all the travel coming up I won't be able to post much, but I'll do my best.