Tuesday, 26 November 2019

Alternative ways of scanning your sensor

It's been a while since my last post. A few interesting methods to scan your sensor came to my attention quite a while back, so here it goes.

The official FreeStyle LibreLink mobile app is finally available in SA. You can scan the Libre Sensor with a phone using this app and the app can then share the values with other phones remotely. You don't need to use only your reader to scan anymore, this app will do it. If you want to use both the reader and your phone, make sure to start the sensor with the reader and not with the phone. The app does have all the feature that you have on the reader, plus a few extra, definitely worth installing it. When you are using the app, you are also helping Abbott collect useful data for research purposes. Abbott already drawn some interesting conclusions by analyzing the massive amounts of data that they are collecting. It seems that people who scan more often, have a much lower HbA1c than those that don't scan often. This does make sense, if you care more about your numbers (scan more often), you tend to try and keep them more in range. The data now just proof this theory to be true on paper.

Install this app on the phone that will be used to scan the sensor: FreeStyle LibreLink (Android)
and this on the followers (parent) phone: LibreLinkUp (Android)
It is also available for iOS, FreeStyle LibreLink (iOS) and LibreLinkUp (iOS)

Way back in 2018 (sjo, time flies, it feels like Yesterday) I broke my femur. Since then I wanted to find another "sport" that wasn't so hard on my bones. Running was/is fun, but the repetitive pounding on the ground isn't always so good for the bones. I was considering kayaking, but finding the time to drive to a dam didn't seem easy. I ended up starting to swim instead. I've never swam properly in my whole life, so putting my face down and blowing bubbles was quite challenging at first. Another challenge was, how do you scan your sensor while swimming? You could use a waterproof bag, or stop after a few laps to do a quick scan and hope the reader doesn't get any water in, etc. But what if you end-up somewhere in the middle of the ocean or dam ? Luckily there is another solution. The Sony SW3 is waterproof. Glimp can be installed on it. NFC can be enabled by installing custom firmware. I followed the instruction from here, and it works perfectly on our 14 day sensors. Just hold the watch on top of the sensor for a second and you have the graph on the screen of the watch, even in the middle of the ocean.

Sunday, 9 September 2018

Carte Blanche Interview

I was lucky enough to be interviewed for a few minutes by Carte Blanche about the #WeAreNotWaiting movement. Read the blog post here: https://m-net.dstv.com/show/carte-blanche/news/taking-control-of-diabetes/news
and watch the story here:

Thursday, 31 May 2018

No more scanning your Libre, with the BluCon NightRider

Sadly the first BluCon NightRider device I ordered way back in January 2018 got "lost" at customs. The good news is that more expensive and reliable (DHL) options are now available and I received my goods with a new order within a week. The NightRider comes in a small blue box, with a one pager instruction manual and a pin that can be used to reset it.
How does it work? The BluCon device fits on top of a Libre sensor. It uses one CR2032 battery. A waterproof version is also now available. Every 5 minutes the BluCon device scans the Libre sensor and sends the data to your phone via bluetooth. There is an official phone application (LinkBluCon) from Ambrosia, but I prefer to use xDrip+ instead. With xDrip+ and with the official application, remote monitoring of the user is possible. You can scan the sensor with the standard Libre Reader without any interference from the BluCon device. In the photo you can see the Libre reader on the right and my phone running xDrip+ on the left.
Physically the BluCon is a bit bulky, and you need to find a way to keep it stuck to the sensor, otherwise it will fall off. I'm using the waterproof version, so I simply put a tegaderm plaster over it and it has been working like that for the whole 14 days of the sensor without any problems.

In the photo below you can see the Dexcom G5 transmitter (top left), G4 transmitter (top right), BluCon (bottom left) and Libre Sensor (bottom right).

Pro's of the BluCon:
  • It turns your Libre system into a real CGM system.
  • You can use it with xDrip+ which means remote monitoring, alerts, speech, etc.
  • Calibrating your Libre sensor is now possible. This is a great advantage over just scanning with the standard reader.
  • Backfilling data is great. If you are away from your phone and come back much later, data get's back filled and you don't loose any of your data.
  • Once off payment. Much cheaper than buying a Dexcom transmitter every few months.
  • Use it when you want to. You can remove it at anytime and continue using it at any time. Your Libre sensor will keep on working. No worries about expensive irremovable batteries.
  • A bit bulky. It is bigger that the other known transmitters.
  • Battery not rechargeable and it seems you need to replaced it every time you replace your sensor.
  • It took a while to get the bluetooth to connect, I had to reset the BluCon several times. Once it worked, it worked well.
Update on my leg: I can walk with two legs, but every step hurts. It takes time for the body to get used to the steel and screws. Eagerly waiting for my 6 month x-ray next month, hoping that the bone grew back as it should. NB: Try to never break your femur, never ever ever.

Wednesday, 31 January 2018

Libre available in SA!!

The FreeStyle Libre is finally available in South-Africa. You can order yours from the Centre for Diabetes and Endocrinology (CDE). They have a pharmacy in Johannesburg (81 Central Street Houghton 2198 Johannesburg), where you can walk in and buy the sensors and reader. You can also call them on (011) 712 6000 and fill in the form, pay via EFT and get the sensors couriered to your door. The current price at the time of writing is R990 for a sensor and R990 for the reader. Much cheaper than Dexcom, and much simpler to use.
It doesn't include remote monitoring, but there are some options. The BluCon Nigthrider attaches to the Libre sensor and sends the data to your cellphone. I'm still waiting for mine, and will report on it as soon as I receive it.

I started the year off on a pretty bad note. I broke my femur in an accident. Very difficult to explain how and why, some of it remains a mystery. During my hospital stay, my Dexcom transmitter suddenly stopped working. As soon as I got home, I ordered Libre sensors and will never look back. Yes, I miss the real-time alarms and updates on my phone (Will get it again once my BluCon arrives), but the Libre is so much simpler to use and much less can go wrong. Insertion is quick and easy, the glue sticks like super glue. While Dexcom sensors contained less and less glue each time I put on a new sensor.... seriously Dexcom?? is it all about the money?? do you really worry that people will get a few more days from a sensor and then you will loose some money??

Below you can see my new Robocop gun holster in the making. I'm still recovering, walking on crutches, 2 more weeks to go non weight bearing. Nervous about all the screws going so far beyond my bone, but glad I still have my leg. Not sure when and if I will be able to run again. Maybe it is time to find a new activity. Happy to have the Libre stuck in my arm, wish I had it during my hospital stay.

Friday, 15 September 2017

Keep running G5, keep running

It's been a while since my previous post.... yes, I started running, and kept on running, when not injured. At first it was difficult and worries about hypo's on the way were huge. It became easier and easier, both the running and managing my BG. At some stage I switched to the Dexcom G5 which is cool because you can use the Sony SW3 as the collector, without having to run with a phone. I ended up always running with a phone on me anyway, it feels much safer to be able to call in case of emergency BG or emergency muscle cramps.

My first half marathon (29 Oct 2016) felt like the Comrades to me, I managed to finish with a time of 2:34 (https://www.strava.com/activities/758897777). The last 7km was very difficult and I had to walk/run/walk/run/...

I kept on improving my time and finished the 2 Oceans half marathon (15 April 2017) with a time of 2:16 (https://www.strava.com/activities/942677147). I felt really good after the race and was slowing myself down all the time during the race. My training routes contain hills, hills and more hills, and eventually hills doesn't seem to be that hilly anymore. That helped me a lot managing the 2 Oceans half marathon hills.

After 2 Oceans, I decided to rather work on pace than endurance. I improved my time even more and managed to do sub 2 hour (1:54) half marathons soon (July 2017) after that (https://www.strava.com/activities/1095300089). In this particular race my Dexcom stopped working after the first 5 minutes. I had to run "blindly" for the rest of the race. Drinking/Eating about every 30 minutes usually keeps BG up without any trouble. It gets more difficult to manage it after a race. All the energy food usually spikes my BG directly after the race and then it starts to tumble down. So, it is important to not correct for the spike too soon, the after-effect of the exercise will let it drop for a couple more hours and you can sometimes see the effect a day or two afterwards as well.

All of this is possible with a CGM and without a CGM. Don't let T1D stop you!!

What's next ? I don't know, for now I just want to enjoy the running freedom and stay alive. I planned a marathon, but after a crazy 28km 600m elevation run (https://www.strava.com/activities/1124592699) I'm not sure if I want to go that far anymore, maybe one day...


Friday, 3 June 2016

Run sick-boy run!

There is a stigma around type 1 diabetics... that they can't do much, can't do some exercise, can't be left alone, can't eat anything, can't look after themselves, .. they are sick... very sick... I mean, they have to take injections every day to stay alive. Well, I'm a type 1 diabetic (T1D) and I want to tell you this stigma is all wrong. Yes, we do need extra management 24/7, but that makes us smarter and stronger. My pancreas is not producing any insulin, but that is not going to stop me from living an active healthy life.

My brother and sister-in-law ran the two oceans ultra marathon twice and did well in the Comrades marathon. Inspired by them and Val Opperman (Also a T1D) who ran the Comrades and the great wall of China marathon, I decided to start with a bit of running. I started off not very fit, the last time I seriously ran was way back in 1997. Other than that I just did a bit of hiking and lawn mowing. You can follow my running adventure on strava where I will be giving my T1D details for each activity. I don't know the answer to all T1D exercise questions and will be learning on the go.

Some of the challenges for a T1D before/during/after exercise:
  • Any injected insulin on board the body can not be removed and can cause a rapid fall in BG while exercising. Hypoglycaemia can make you unable to think or move. Even the long acting insulin can cause hypo's during exercise. 
  • Without insulin production, an adrenalin rush will spike blood glucose (BG) quickly to extremely high values.
  • After exercise BG can keep on falling for hours and hours.
  • So, a T1D needs insulin, even during exercise, but it gets tricky to manage. Everyone differs and what works for one might not work for another.
  • It seems that carbs need to be consumed at regular (15-30 minute) intervals during exercise to keep BG stable.

My T1D survival running equipment can be seen in the image, which adds another few kilograms to my weight that I need to carry with me on the road:

A. Dexcom sensor. Inserted in my upper arm.
B. Dexcom transmitter. Connects to the sensor and retrieves a BG value every 5 minutes.
C. xBridge device. Captures the signals transmitted by the transmitter and sends it to my cellphone.
D. Cellphone. Retrieves the BG values from the xBridge device. Reads out the BG values with maximum volume and uploads the values and my location to the internet. I use xDrip+.
E. Emergency power bank in case of any flat battery issues.
F. LifeQ wrist based sensor. Logging raw data and things like spo2, vo2, epoc, blood lactate, ...
G. Garmin watch. Keeping track of my location, pace, distance, cadence, ...
H. Chest strap heart rate monitor. Connects to the Garmin watch.
I. Camelbak dart 1.5l hydration backpack. All the other items are placed inside the pockets of this backpack.
J. Energy bar. Placed in a pocket of the backpack that can be easily reached while running.
K. DexD tablets. Fast acting glucose tablets.
L. Camelbak bladder. Filled up with an energy drink like powerade, energade or lucozade. Can easily take a few sips without stopping. Keep my hands free.
Z. Things not shown in the image. Insulin pen if I need to inject for some reason and glucagon kit in case I can't get my BG up.

Friday, 1 April 2016

10-year diaversary!

I was diagnosed in March 2006,.. that calls out for a ten year diaversary! I have a lot to be thankful for, a lot has happened during these 10 years. I could have been dead, but I'm alive. It is a crappy disease, but I'm more convinced than ever that there is a greater purpose of me being a T1D. The past year has been amazing, I don't really have words to describe it. For the first time in 10 years my HbA1c tested below 6, at a value of 5.9. Below is a screenshot of my desktop, showing the real-time glucose graphs of 4 T1Ds wandering around somewhere in the country (2x in Johannesburg, 1x in Cape Town, and me in Pretoria). If you would have told me a year ago that I will be sitting at my desk and watch the glucose trends of these 4 individuals in real-time... I would have laughed and told you "NO Way! Seriously ? Is that even possible ?!". A year ago I was used to only finger pricking tests, missing lots of highs and lows at crucial times. I knew there were something called a CGM, but it was always way too expensive and not available in our country and it seemed like you need to have a pump to possibly get the CGM. So, my life changed when I randomly (I don't really believe in random, things happen for a greater purpose) stumble across a page that advertised the FreeStyle Libre... thereafter I discovered the Dexcom, xDrip, Nightscout, .... technology explosion..

I've been switching over to xDrip+ (plus). With the plus version you can log insulin and carb intake. The insulin logging is especially useful when you quickly want to see how much insulin is still going to be released and when. Rapid insulin takes about 2-3 hours to completely be used up, if glucose values still rises after that, it indicates that you did not inject enough for the food you ate. Sometimes when injecting multiple times within 2-3 hours can also lead to a stacking effect that can become dangerous if not monitored. The logging helps making more intelligent decisions in order to prevent stacking. xDrip+ can be found here: https://github.com/jamorham/xDrip-plus
Below is a few screenshots of xDrip+ in action. The green line at the bottom shows the insulin on board. The middle image shows a case where values started to go up when the insulin was depleted (in the middle of the night).

I also integrated a wixel and BLE module directly with the battery of a vodacom smart kicka cellphone, which basically replaces the need for a Dexcom Receiver. xDrip runs on the phone and uploads the data to be viewed on a Nighscout website and pebble watch. Image of the integrated device below.

I will end this post with a lame video I made a while back showing the options to get your Dexcom G4 connected to Nightscout for remote monitoring.