Please Do Not Remove My Batteries

As of Saturday, March 6, at 10:40 AM, I am one step closer to having my robot pancreas.

I have, through a combination of landing the best endocrinologist in the Kaiser system and being a persistently squeaky wheel, gotten my Medtronic Minimed Continuous Glucose Monitoring System. I am phenomenally excited about this development, and not only because I get to imagine myself as a sexy anime cyborg: I love data, and my heart beats with a quick rhythm at the thought that I will soon be able to improve my diabetes care, and resultantly the quality of my daily life, with the help of more data and more data analysis. With this CGM, I hope to get a better picture of where I stand, and with that I hope to build a better system for getting me where I need to be.

So, some notes from setting up my newest biogadget:

Getting the goods

Just in case you had any doubts that medical devices were a high margin product, know that I received several calls from several different Minimed representatives, each of which went over some aspect of the delivery, pricing, billing, or training that would be scheduled. The Medtronic box arrived via 2-day UPS shipping on Friday evening, with a trainer due to call me the following week.

When I opened the box, my first thought was that perhaps they had accidentally delivered some sort of Klingon weapon. I quickly realized, though, that the oddly shaped, spring-loaded device was the assistive inserter for injecting the sensor into my abdomen. The insulin pump comes with a similar device. I hate that thing. The mere thought of a spring-loaded, large-bore needle pointed at my stomach makes my cringe.

After investigating the various components (Klingon injector, little blue thing, bigger blue thing, small white flying saucer), I pulled out the instructions. While I had no intention of waiting to receive training, I did at least intend on reading the instructions.

Step 1: Charge your new MiniLink REAL-Time Transmitter.

Takes up to eight hours to charge the first time? Really? Lame! I was to ready to get going! Luckily, the actual charging time was only 15 minutes, a far cry from the threatened eight hours. I was pleasantly surprised.

Step 2 through One Million: Read each and every one of the many brightly colored instruction booklets included in this box, plus anything Minimed has ever sent you, ever. Oh, and:

DO NOT insert a glucose sensor or use your MiniLink Transmitter until you have attended training.

Yeah, right. Moving along, I identified the pieces I needed (box of sensors, transmitter), and tried to figure out how to get the thing on me. Unfortunately, the instructions only showed how to do it with the evil spring-loaded needle-shooter. So I was on my own.

I opened one of the sensor packages. Wow. That is one big needle. I use the Minimed Silhouette infusion sets, which are pretty big themselves, but this guy was thick. And the angle was more severe than the Silhouettes, which made me think queasily about where the tip was going to land inside of me. And the sensor itself looks like a giant mosquito. Yikes.

It took me about three tries to finally get the sensor inserted. The first two tries I got the tip in, and then bailed as my fingers began to slip and I couldn’t seem to get sufficient tension to push through the elastic skin into the interstitial fluid. Once the sensor was in, though, I realized I didn’t know how to remove the needle part to leave only the sensor behind. In all the provided instructions, the injector seems to take out the needle automatically, so there was no indication of how to do it by hand. I pulled a little, but nothing happened. So there I was, half naked, beginning to panic because I had a large, sharp object hanging out of my abdomen. Breathe. It’s got to be just like the pump infusion set, right? The plastic part disconnects, and the needle can be extracted. I pulled harder, and felt the plastic inserter begin to disconnect, pulling the needle back with it. Sigh of relief.

Watching the Pot Not Boil

That was just the beginning, though. Next came the waiting. Ten minutes of letting the sensor get “wet with interstitial fluid.” (Ew. Way to word that one, Minimed.) Then FOUR HOURS before the sensor began to actually tell me anything. Four hours of startup time! Now, in retrospect, that doesn’t seem so bad, especially considering I had no continuous sensor before. But still! During that four hours, I checked the thing every ten minutes, and it wouldn’t tell me anything. Which leads me to an important note for Minimed developers, medical device designers, and anyone who designs a user interface for anything, anywhere: if the user is waiting for something, show the user a visual indicator that something is happening. A loading bar. “Waiting for data.” An hourglass. The Mac spinny beachball. Anything! Tell me something is happening! All that the pump said was “Sensor Start,” so I was unsure if that meant “It’s in the start-up phase,” “It has been started,” or “You did it wrong; start the sensor again.” I do not like waiting, unsure of whether I should restart the whole process.

The Payoff

But then. Finally. I start getting data. Blood glucose measurements! Every five minutes! If you are not a diabetic or not a geek, this may not mean much to you. To me, this is awesome. Yes, literally– awe inspiring. This will make my life so much easier.

And one weekend in, it has: I can monitor my blood sugar while taking a yoga class. I can know that I’m 77, but stable, so no need to correct. I can know I’m 122, and heading up, so better get moving. Sigh. I love medical advancement. I love healthcare.

And an additional note to those of you without continuous glucose monitoring, which is likely most of you: fight for it, it’s worth it. If you’re with Kaiser, send me an email, and I’ll tell you what the magic words are. And if you have any sort of sway with the government, or with healthcare providers, make it loud for sake of the rest of us diabetics: please help us get the tools we need, not to live normal lives per se, but to live healthy lives.

Karmel Allison

Karmel was born in Southern California, diagnosed with Type 1 Diabetes at the age of nine, and educated at UC Berkeley. Karmel now lives in San Diego with her husband, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and learning to use the active voice when talking about her diabetes.

Karmel Allison

Karmel was born in Southern California, diagnosed with Type 1 Diabetes at the age of nine, and educated at UC Berkeley. Karmel now lives in San Diego with her husband, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and learning to use the active voice when talking about her diabetes.