Double trouble

Has this ever happened to you?

You come home from work and the kids jump all over you eager to tell you about their day. You try to get a few words in with the babysitter before she leaves while your kids are still trying to butt in every few seconds. You finally give them a few minutes each but then you really need to get dinner going. While you start cooking you try to estimate both carb content and timing of the meal and take your bolus while trying to figure out why one of the kids is now crying. Tripping over some toys that weren’t there 2 minutes ago you finally get dinner on the table and sit down to eat. Things are calmer now at the table and you think how your blood sugar has been reasonably well behaved today and you really should have pre-bolused for this meal. But whatever, better late than never. So you do the math and bolus while hearing about who was sitting beside whom at lunchtime at school. Then 45 minutes later as the kids are getting into bed and wanting a last pee, a last drink of water and a last kiss, your Dexcom starts blaring and your first thought is “I can’t be under 55, if anything I under-bolused for that meal and my 2 week old Dex sensor must just be showing its age”. Then the symptoms hit. Hard. And both Dexcom and Libre are reading LOW. And only then you think “Did I… No, I couldn’t have…” Then you look in your pump history to find that yes indeed, you bolused twice for that meal, 23 minutes apart. Then you drink the rest of the orange juice in the house and sit down and wait to feel human again, thankful that your husband is now home from work.

Result of a double bolus.

Result of a double bolus.

Yeah, me neither. Until yesterday.

I’m pretty sure I haven’t made a mistake like that since going on the pump almost 14 years ago. I’m glad that my boluses are relatively small so that I only took 3.35u twice rather than much more. I’m also glad that I have a pump so there is actually a record of past boluses. I have now programmed my pump to alert me if I try to take more than 7u (basal rate included) within an hour.

Stay safe! Don’t double bolus!

Premières impressions du FreeStyle Libre

Je suis maintenant dans la deuxième semaine de mon essai d’un mois avec le nouveau système “Flash” d’autosurveillance du glucose de chez Abbott : le Freestyle Libre. Ce dispositif devrait être disponible en France à partir de mi-octobre selon le fabricant, mais lors de mes contacts avec eux, la date précise n’est pas encore connue. Nous sommes plusieurs en France à le tester avant la sortie officielle. Les témoignages de chacun peuvent aider à déterminer si ce capteur peut être intéressant pour la gestion de votre diabète. Allez également lire les blogs V_A_U_D.com, Diabète Base et DiabeticTeacher.

Je tiens à préciser un facteur qui influence mon opinion du Freestyle Libre. Je porte un lecteur de glucose en continue déjà depuis un an : le Dexcom (disponible en France pour les porteurs de la pompe Animas Vibe). Le système Flash d’autosurveillance du glucose n’est pas tout à fait pareil que la lecture en continue “traditionnelle” et chacun a ses avantages et ses inconvénients.

Dexcom à gauche

Dexcom à gauche

Libre à droite

Libre à droite

Donc voici un premier billet sur mes impressions du Freestyle Libre. J’en promets d’autres au cours des prochaines semaines.

Le capteur
Il est facile et complètement indolore à poser. Un dispositif d’insertion est fourni avec chaque capteur. Il est équipé d’un ressort qui se déclenche automatiquement en appuyant le dispositif contre le bras. On sent plus la pression du dispositif que l’insertion à proprement parlé de l’aiguille. Le capteur est porté à l’arrière du bras et le geste de l’application peut être fait facilement avec une main que ça soit à droite ou à gauche. Je suis droitière et j’ai fait exprès de poser mon premier capteur à droite avec la main gauche.

Le capteur lui même est plus petit que d’autres capteurs de lecteurs de glucose en continue qui sont disponibles. Il est très confortable, même si on dort sur le coté la nuit.  Il n’est épais que de 5mm et tout rond, il ne s’accroche donc pas trop sur les vêtements ou les hanses de sac à main. Je le trouve clairement plus “joli” que mon capteur de Dexcom. Cela dit, une différence entre les deux dispositifs (et non la moindre) : le Libre ne transmet pas automatiquement les données au lecteur. Il faut physiquement le scanner, il n’y a pas d’alertes de glycémie trop basse ou trop élevé avec le Libre.

Porter le capteur
Le capteur à une durée de vie de 14 jours. C’est deux fois plus long que le capteur dexcom, qui, à son tour, est déjà plus long que les capteurs Navigateur ou Enlite. Cette durée de vie pourra être intéressante, les capteurs ne seront bien entendu pas remboursés pour l’instant par la Sécurité Sociale. L’écran d’accueil du lecteur affiche le nombre de jours restant du capteur en cours d’utilisation. Le patch autocollant du capteur ne dépasse que de quelques millimètres, j’ai demandé à Abbott s’il pouvait vraiment rester collé 14 jours avec aussi peu de surface collante. Ils m’ont assuré que oui voire que j’aurais peut-être du mal à le décoller au bout des 2 semaines.

Ca commence à se décoller au bout de 6 jours

Il commence à se décoller au bout de 6 jours

Malheureusement pour moi, j’ai eu raison de m’inquiéter. Au bout de 6 jours les bords commençaient à se décoller. La pharmacienne m’a proposé un autocollant transparent pour recouvrir le tout et j’ai hésité. La vie quotidienne reprenant le dessus j’ai trop attendu pour m’en occuper et le matin du 8e jour, le capteur est tout simplement tombé.

J’ai l’habitude de porter mes capteurs de Dexcom de 3 à 5 semaines. Ils restent collés aussi longtemps car je recouvre l’autocollant intégré avec des bandes autocollantes pour athlètes. Le bord de l’autocollant Libre n’est cependant pas assez large pour utiliser cette même technique. J’ai déjà posé mon deuxième capteur et je serai plus vigilante cette fois pour qu’il ne tombe pas.

Scanner le capteur
Il est facile de scanner le capteur avec le lecteur pour avoir les données de taux de glucose et de tendances. Un unique bouton sur le lecteur permet de le réveiller. On place ensuite le lecteur à proximité (max 4cm selon de fabricant, 6cm selon mes mesures) du capteur posé sur le bras. Le résultat, la tendance et la courbe des 8 dernières heures sont affichés sur l’écran de façon instantanée.  Vous pouvez choisir un bip, une vibration ou rien au moment du scan. Il lit à travers des vêtements mais je ne sais pas comment il se comporte en cas de températures extérieures très basses (il peut être pratique de connaitre sa glycémie en faisant des sports d’hiver!).

Fiabilité et précision des données
Comme noté par Abbott, les 24 premières heures avec un nouveau capteur sont “les moins précises”. En effet, après avoir attendu les 60 minutes obligatoires après la pose du capteur, le premier scan que j’ai effectué m’a donné le résultat “LO” (c’est-à-dire moins de 0,40 g/L)!

Sans symptômes, j’ai quand même effectué une glycémie capillaire et le résultat de 0,87g/L me semblait plus vraisemblable. J’ai attendu une heure supplémentaire et là, le capteur Libre, le capteur Dexcom et mon lecteur classique étaient tous plus ou moins d’accord, en tout cas dans la limite de la précision obligatoire pour les lecteurs de glycémie.

2 heures après la pose du capteur

2 heures après la pose du capteur

Depuis, je trouve que les résultats sont très proches de mon lecteur et les tendances quasi-superposables avec les courbes dont j’ai l’habitude de Dexcom.

Accuracy2

12 heures de données pour Libre et Dexcom

J’ai demandé à Abbott si on pouvait calculer les doses d’insuline pour un repas à partir des résultats donnés par le capteur. La réponse, très politiquement correcte, “il faut en parler avec votre professionnel de santé”. Mais, pour l’instant, je connais mieux cette technologie que ma diabétologue, je suppose que sa réaction serait de faire une glycémie capillaire avant chaque repas.

Pour ceux qui aimeraient utiliser le calculateur de bolus du lecteur Libre (que je n’utilise pas car il y en a déjà un intégré à ma pompe à insuline), il ne peut être utilisé que dans les 15 minutes après avoir effectué une glycémie capillaire avec le lecteur Libre. Le Libre utilise les mêmes bandelettes que les lecteurs Freestyle Optium ou Neo.

L’effort de marketing d’Abbott par rapport à ce dispositif repose beaucoup sur le fait qu’il permet d’éliminer la contrainte de la piqure au bout du doigt (et ainsi permettre toute sorte de sensations plus douces …. etc etc etc). Mais, dans la réalité, il faut quand même se piquer un peu – pour le calcul de bolus, pour vérifier une hypo ou une hyper, à chaque fois que l’on questionne le résultat du capteur…

Ce qu’il permet, par contre, c’est de vérifier son taux de glucose (et en plus de voir les tendances) de multiples fois par jour tout en limitant les piqures au bout des doigts. Pour l’instant, j’ai une moyenne de 16 scans par jour. C’est peut-être un peu excessif mais c’est dans le but d’apprendre le maximum sur le dispositif et le comparer avec d’autres technologies. Si jamais je décide d’acheter un Freestyle Libre et de l’utiliser sur le long-terme, j’imagine que “l’obsession” serait moindre.

Je vous laisse digérer tout ça… La prochaine fois, des détails sur les fonctionnalités du lecteur et l’analyse des données disponibles sur le lecteur et sur le logiciel téléchargeable.

First impressions of the Freestyle Libre

I am now a week and a half into my one month trial with the soon-to-be-released (in Europe) Abbott flash glucose monitor, the Freestyle Libre. By now there are several places on the Internet to get info about what this new diabetes monitoring device is and how it works. For starters, you can go HERE (I hope that webiste works outside of europe). There are also a number of other bloggers who are trying out the system and since YDMV (your diabetes may vary) I would suggest reading many posts about different experiences with the Libre to get a better idea as to whether it would be a good option for yourself. Check out user reviews by Laura, Mike, Jen and Dave.

One of the most important factors that is influencing my own opinion of the Libre is that I have been using a dexcom CGM for the past year. Flash glucose monitoring is not the same as a “traditional” CGM and it definitely has some advantages and some drawbacks.

Dexcom on left arm

Dexcom on left arm

Libre on right arm

Libre on right arm

This is the first of several posts about this device and I’m going to break them up into individual features that I find are worth considering and give my take on the pros and cons of the Libre. FYI and as illustrated by the fact that I still use an insulin pump that has been off the market for 5 years, I’m quite picky about the features in my diabetes devices. So here goes… Some of my thoughts after 9 days using the freestyle Libre:

Sensor
It is very easy and virtually pain free to insert. The insertor is spring loaded and the action of pressing it onto the arm releases the spring. You feel the pressure of the device on your skin more then the insetor needle going in. It’s easy to do one handed and on either arm no matter if you are using your dominant hand or not.

The sensor itself is smaller than other cgm sensors I have seen. It’s quite low profile (5mm thick) and round so doesn’t get caught on clothing or purse or backpack straps. It’s definitely nicer looking than the dexcom 4G sensor and transmitter. That said, an important difference between the two is that the Libre doesn’t automatically transmit any data. I’ll get back to that in another post.

Duration 
The sensor is meant to last upto 14 days. That’s twice as long as the longest CGM sensor on the market! And of course this could be interesting in terms of cost (I’ll get back to that too!). The meter has a countdown on the home screen to let you know how many days are left. The tape around the sensor is impressively small and I asked the reps at Abbott if it would actually stay stuck for 2 weeks without the need for extra tape. They assured me that it was very sticky and I might even have some difficulty peeling it off at the end of the 14 days.

Not so sticky after 6 days

Not so sticky after 6 days

Unfortunately that didn’t turn out to be true for me. After 6 days, I noticed that the edge of the tape seemed to be peeling up. I had heard of “liquid tape” being spoken about on the diabetes online community and enquired in a pharmacy where they didn’t seem to be aware that anything of the sort existed. I hesitated to buy tape to cover the whole sensor and wasn’t sure enough in my abilities to cut a hole in the tape to the exact dimension of the sensor to be able to overlap the tiny bit of tape already there.

Between a busy work and home life, I didn’t take the time to explore more options for glueing or taping the sensor back down quickly enough and on Saturday morning, 7 1/2 days after putting it in, the sensor simply fell off. I’m pretty sure my dexcom sensor would do the same after 7 days if I didn’t reinforce the tape by the end of the first week. It is only with careful taping and retaping that I am able to get multiple weeks out of a dexcom sensor. But a dex sensor is only supposed to last a week. Libre should be able to last 2.

Reading/scanning 
It’s very easy to obtain a reading from the sensor. Simply press the (one and only) button on the meter and bring it close to the sensor on the back of the arm. The reading, the trend arrow and the graph from the last 8 hours appear instantly. You can also chose to have it beep, vibrate or do nothing at all when you scan the sensor with the meter. It can read through clothing so is convenient in almost any situation. I’m curious about the cold weather though. I noted last winter while on vacation in Canada that my dexcom had a little trouble with the very cold temps. And if using the Libre, you’d have to take it out into the cold to scan through a jacket.

Accuracy
As noted by Abbott, the first 24 hours with a new sensor is indeed its “least accurate period”. I was all set to do my first scan at the end of the one hour startup period. Much to my surprise, the meter read LO (meaning under 40mg/dl or 2.2 mmol/L).  Not having any symptoms of a low, I tested with a finger stick using my regular glucose meter. The 87 (4.8mmol/L) staring back at me made much more sense. But another hour later, all 3 of my devices were in very reasonable agreement:

2 hours after insertion all devices agree

2 hours after insertion all devices agree

Since then, I can find no fault in the accuracy compared to dexcom or my meter (especially given the liberal definition of accuracy allowed on glucose meters).  I asked Abbott about dosing insulin off a scanned Libre reading. They gave a vague “talk to your medical professional about it” type of response. But in all honesty, my hcp won’t know this tecnology well enough to give an informed opinion on it and will of course say “only dose insulin for a meal or a correction bolus off a finger stick reading”.

Plus, for anyone who would like to use the bolus calculator included in the meter (I don’t bother as I have that feature in my insulin pump), it can only be used within 15 minutes of a finger stick test using the Libre meter.

Abbott has put a good deal of marketing into the fact that this new flash glucose monitoring technology eliminates the need to stick your fingers (allowing you to enjoy all sorts of gentler sensations with your fingertips… Yadda yadda yadda). But in reality there is still some need for testing, even if you aren’t calibrating the sensor twice daily like with some CGMs.

What the Libre does permit though, is checking glucose levels multiple times per day while only doing a few finger sticks. So far I’ve averaged 16 scans per day which seems like a lot (obsess much?) but also has to do with the fact that I’m testing out the device and comparing it to my meter and my dexcom.

In the next post I’ll get into some of the features of the meter and the data & analysis available both on the meter itself and in the downloadable software.

Système Flash d’autosurveillance du glucose : FreeStyle Libre, un essai d’un mois

C’est la première fois que j’écris en français sur mon blog. Désolée si ça se lit un peu comme une traduction de l’anglais… c’est le cas ! Et merci de me pardonner s’il reste quelques fautes de grammaire…

Au cours des prochaines semaines, je souhaite partager mon expérience du nouveau dispositif d’autosurveillance de glucose de chez Abbott, le Freestyle Libre. Ce lecteur vient de recevoir la marque CE pour la commercialisation en Europe et sera bientôt disponible en France.

Pour commencer il faut que je précise :

J’ai été invité par Abbott à pré-tester le nouveau système FreeStyle Libre qui vient de recevoir la marque CE en Europe mais qui n’est pas encore commercialisé. J’ai reçu gratuitement de la part d’Abbott, le lecteur Flash et deux capteurs (à porter 14 jours chacun). Je remplirai un questionnaire pour le fabricant sur le dispositif à la fin du mois et autrement je suis libre de parler de mon expérience comme je le souhaite. A la fin de mon essai, je rendrai tout matériel non-jetable à Abbott.

Kit de démarrage du Freestyle Libre

Bon, c’est dit, donc je peux commencer… Je suis très contente de pouvoir tester ce nouveau dispositif car c’est le premier lecteur de ce type à être fabriqué. D’après les vidéos que j’ai pu regarder sur le site dédié, je vois déjà des avantages par rapport à un lecteur de glycémie “classique”. De plus, je porte un lecteur de glucose en continue (Dexcom) depuis un an maintenant et j’ai hâte de pouvoir comparer les deux méthodes de suivre ma glycémie.

Quelques avantages évident du système Freestyle Libre :

  • Il n’a pas besoin de calibration, c’est-à-dire, plus besoin d’effectuer de piqure au bout du doigt pour connaitre son taux de glucose et autant de fois par jour qu’on veut ! Mais bien évidemment, la consigne donnée est de tester sa glycémie par une goute de sang si jamais il y a un doute ou pour vérifier une hypoglycémie.
  • Chaque capteur aurait une durée de vie de 14 jours (et j’espère bien que ça reste collé aussi longtemps!!)
  • Le capteur garde des données en mémoire, ce qui veut dire qu’on peut s’éloigner du lecteur pour jusqu’à 8 h sans perdre des données.

Pour l’instant le point négatif qui me saute aux yeux comparé à la technologie que je porte actuellement, c’est qu’il n’y a pas d’alerte pour une glycémie trop basse, trop haute ou qui change très rapidement en montant ou descendant.

Abbott s’appui fortement dans leurs efforts de marketing sur le fait qu’il n’y a plus besoin de se piquer le doigt – à mon avis ils vont un peu trop loin. Dans une des vidéos “teasers” qui sont sorties il y a quelques semaines, il y a la phrase “ce sont les mains qui sont le plus affecté par le diabète”. Je ne peux pas être d’accord. Autant je serais contente de laisser mes pauvres doigts tranquilles, je dirais que mon diabète a beaucoup plus d’effet sur mes émotions et ma santé mentale, sans parler du côté physique des hypers et des hypos quotidiennes et la planification, les calculs et l’organisation qui rempli bien les journées!

Pour l’instant je ne peux pas donner d’avis spécifique sur le produit car je vais poser mon premier capteur vendredi prochain. Par la suite, je ne manquerai pas de relayer mes impressions. Pour l’instant, je ne peux que réjouir du fait que des nouveaux dispositifs de ce type soient développés et commercialisés. Cela dit, commercialisé ne veut pas forcément dire accessible. La sécurité sociale n’est pas encore prêt à rembourser cette nouvelle technologie et je n’ai encore aucune idée de son coût réel (ça sera une de mes questions pour Abbott!).

Donc revenez voir mon blog au cours du prochain mois si vous voulez en savoir plus sur le lecteur Freestyle Libre. Si vous avez des questions, je ferai de mon mieux pour y répondre.

Vous pouvez également suivre les impressions de Fred sur ce nouveau lecteur sur le site de VivreAvecUnDiabete.com.

Freestyle Libre glucose monitoring system – 1 month trial

Over the next month, I am going to be trialling the newly CE approved Freestyle Libre glucose meter by Abbott. This meter has received a whole lot of press this past week (HERE and HERE and all over the diabetes online community on twitter and Facebook) when the news came out that it was going to be released in Europe.

Starter kit for Freestyle Libre glucose monitoring system

I’m going to start right off the bat with the disclaimer :

I have been invited by Abbott to test out the newly CE marked Freestyle Libre glucose monitor, slightly before it is officially released in Europe. I have received the meter and 2 sensors (to be worn 14 days each) free of charge from Abbott. At the ed of the month-long trial, I will be filling out a questionnaire on the system and I am free but not obliged to write more about my experience. I am not being paid to participate in this trial and will return all non-disposible material after the trial to Abbott.

There, now that that’s out of the way, I’m very excited to give this new product a try. From watching a few videos online, I can already see the many advantages it has over a regular blood glucose meter. However, I’ve been wearing a Dexcom CGM for a year now and I am unsure how I’ll feel about some of the differences between this new device and a CGM.

Some of the most obvious perks of the Libre :

  • It requires no calibration, not even at start up – and has only a one hour startup “blind” time. (Although precaution is of course give to test your blood glucose level with a finger stick test if unsure of the Libre reading or to confirm a low.)
  • Sensors are to be worn for 14 days (and I hope they stay stuck that long!!).
  • The sensor stores data so you can be away from the “reader” (hand held part of the kit) for up to 8 hours with no gaps in your graph.

The most obvious downside, at least compared to my current technology, is that it is not a continuous glucose monitor and since I have to scan the sensor for readings, there are no alerts to lows or highs or rapidly rising or falling blood sugar levels.

Abbott is leaning heavily on the “no finger pricks” in their marketing effort – almost too far in my opinion. In one video released in France, they go as far as to say that fingers are what is most affected by diabetes. I strongly disagree with this statement. Even if I would love to give my poor finger tips a break, diabetes has a far greater influence on my emotions and mental health, not to mention the physical side of dealing with daily highs and lows and all the D-planning, D-math and D-organisation that fills my days.

I can’t say much more on the specifics of this new product yet as I won’t be inserting my first sensor until friday this week but I will report back with how I feel about it once I’m wearing it. So far, I’m excited that new technology like this is becoming available. Of course being available and actually having access is another question. As far as I know, there will be no reimbursement for this new product in the European countries where it’s being released over the coming months. I have no idea what the cost will be but that will be one of my questions to Abbott.

So stay tuned over the next month and I promise some feedback and would be happy to try to answer any questions people may have.

New pump or not new pump?

With all these #showmeyourpump pictures filling up the internets, I thought I’d share some of my thoughts around my pump choices.

I first started pumping in 2000 with a minimed 508. I loved that pump because it was what gave me my first taste of the freedom of different basal rates throughout the day and to be able to take a meal bolus with the touch of a button. I still have my old 508 along with a set of batteries and a couple of reservoirs – just in case. When minimed’s (or was it already Medtronic by then?) first paradigm pump came out – the 511 – it was the natural “next pump”. However, if I remember correctly, the 511’s features were about the same as it’s predesessor; it was mostly the outer physical aspect of the pump that was upgrated at that point. I didn’t stick with it for long.

Cozmo was the first “smart pump” on the market and I was lucky enough that France was the second country in the world where it was available. It came out in the US in late 2002 and Smiths Medical decided to use the World Diabetes Congress in August 2003 in Paris to launch the pump to the rest of the world.  I got my first Cozmo about a week before the WDC.

Any time I have needed to switch pumps since then (for warranty or malfunction issues), I have always chosen to stick with the Cozmo despite the fact that all pump manufactuerers have come out with several newer pumps over the last decade and despite the fact that the Cozmo itself has no longer been available since 2009.

In France, all insulin pumps and pump supplies are ordered through specialised medical supply companies. They buy the pumps and supplies from the manufacturers and patients “rent” the pump and buy supplies from these third party suppliers (covered, thankfully, by French social security – the famous “Sécu”). So, lucky me, even though Smiths Medical took their pump off the market, my supplier still has some in stock and it is still avalable to me – at least until they run out of reservoirs.

#showmeyourpump

After 11 years, I still love my Cozmo with its personalisable menus and features. I choose to use an insulin pump partly because it makes it easier to adapt my diabetes to my lifestyle and I love that I can adapt my Cozmo to my own habits and needs in terms of diabetes management.

That said, after 5 years now with no updates, I figure it is worth looking at what else is out there.  I’ll spare you the full details of my pump comparison but one negative aspect of this process for me was that there are only 3 pump options here in France :

  • Roche Accu-Check Spirit Combo
  • Animas Vibe
  • Metdtronic Veo 554 (which I think is equivalent to the  MiniMed 530G system in the US)

When you look at some of the unique features of the T:slim, the Omnipod or the Snap pumps, it is disappointing that those are not at least options here.

With the choices available to me and my own preferences in terms of features that are important to me in a pump, I chose to weigh the pros and cons of staying with my Cozmo or switching to an Animas Vibe.

To get to know the Vibe a bit better I talked with a nurse educator at my pump supplier and she showed me some of the main features. I talked to people using the Vibe locally and on social media to get their impressions. I posted detailed questions on diabetes forums asking which of features I love on my Cozmo might also be available on the Vibe. Finally, still unsatisfied that I didn’t get the nitty gritty of the comarison that I was looking for, the geek in me decided to download the user manual, which I read cover to cover.

The Vibe looks like a great pump and I know many people who use it and are very happy with it. It has certain features that I would like to have on a pump and don’t have today, like showing my dexcom graph, or different insulin sensitivity factors at different times of day. I would trust it’s waterproofness more than my current 4+ year old Cozmo and I could use software like Diasend to compile a majority of my diabetes data. These would be definite advantages of switching.

However… after much thought, there are still too many features on my Cozmo that I use daily or weekly that are not available in the Vibe (or any other pumps available to me) that have made me decide to stick to my status quo.

Just to name a few:

  • size, shape and light weight (though I’d be happier if the Cozmo was slightly less thick)
  • user set site change reminders (even though most often change my sites every 2 days, I have a hard time remembering when the last change was)
  • the ability to save temp basal rates that I use often
  • detailed history feature including daily carb intake, %of basal insulin and averages
  • fewer button presses to complete any action
  • the intutive nature of the screens (right and left buttons make navigation easier)
  • very personaliseable reminders & alarms (although there is one more that I would like to add)
  • can give a quick bolus using unit of insulin or grams of carbs
  • a battery change only involves changing the battery (no re-priming of reservoir or losing stored data)
  • a low reservoir alarm at a only 5u left (rather than a minimum of 10)

All these years later, I am still disappointed that Smiths Medical decided to leave the diabetes business. They had a great product and I will continue to use it as long as I still have access to replacements and pump supplies.

If you use an insulin pump, I’d love to know what features were deciding factors for you in chosing your particular pump.

Eating out with D and CD

This past week my husband and I have been childless as the girls are spending 10 days with their grandparents. It’s been eerily quiet at home but we’ve been productive with things that are difficult to do with kids under-feet (like go to Ikea and put up new wardrobes). We have also taken advantage of spontaneously being able to go out in the evening to dinner or a movie. And, since next week is our wedding anniversary (8 years!) we planned an evening out in a very nice parisian restaurant. Lucky for us, there is no shortage of choice in that regard!

A neighbour had recommended Saturne. When my husband made the reservation, he gave them a heads up about the fact that my meal needs to be completely gluten free. Eating out is always risky when you have celiac disease but luckily, I rarely have an issue in french restaurants finding gluten free food on the menu. In fact, I have insulted a few chefs over the years just by asking if the sauce might be thickened with flour (Of COURSE not, madame, we only use crème fraiche!!). I know what I generally need to avoid and what dishes are usually ok and I know where the possible stumbling points are (like a biscut sticking out of the top of a chocolate mousse). I’ve got my gluten explanations down pat in french and I have found that the nicer the restaurant, the easier it is to deal with the gluten issue.

We were glad we made a reservation as the restaurant was booked out despite the fact that we went mid week in the middle of july (when half the population of France is on holidays). After we were seated, the first thing the server said was that it was a “carte blanche” 6 course menu with 2 starters, 2 main dishes and 2 desserts, but we would have no idea what would be served until it was actually on the table.

I love being surprised by food since 99.9% of the time I know exactly what I’m eating, both in terms of making sure it’s entirely gluten free and doing my best to guestimate carb content. But it was the next question from the server that really made me smile “Do you have any food allergies?”. This question was asked at each table so we hadn’t actually needed to mention the gluten when we made the reservation.

Food allergies are not a “thing” in France. You aren’t generally asked when invited to someone’s home or when you register for a conference or banquet dinner if you are vegetarian or have any allergies.

In this situation it makes sense that they ask given that everyone in the restaurant are eating the same meal but it is not a question that you’d hear very often around here. They actually told me that the whole meal is gluten free anyway so no worries.

And it was fabulous. A variety of textures and mixes of flavours, beautiful colours on each plate and different types of plates with each course. I should have taken more pictures. Here is the second starter of lobster wrapped in leek and topped with fresh almonds and some tasty greens.

SaturneDinner2

It’s always difficult to bolus correctly for meals like this but I managed with a  small square bolus at first and a regular bolus once I saw the desserts. There were minimal carbs in the first 4 dishes and I wasn’t too hard to guestimate the carbs in the desserts (or, more likely, I got lucky!). My blood sugar stayed below 160 the whole meal and I’ll give partial credit the wine that accompanied each dish for keeping my blood sugar steady around 110mg/dl all night.

The only hiccup in the meal was the last dish which was like a chocolate mousse with a dollop of hay-infused cream and topped with bits of brownie.  I politely declined and when the server remembered that I was “the one with the gluten intolerance”, she quickly took it away and brought back a very chic fruit salad with green and orange melon, rhubarb and apricots, sprinkled with a variety of fresh herbs.

With the title of this post, it sounds like I’m going out to dinner with friends! Unfortunately I don’t have the choice to leave these two “friends” at home but I certainly don’t let them stop me from going out and enjoying myself.  I am so appreciative that I can trust a restaurant to give me a truly gastronomic meal with little fear on being “glutened”.

It was a lovely and relaxing evening out and a wonderful way to celebrate 8 years of marriage.