Six-month T1D Check-up: From the Couch

September 3, 2020
Kameran Ulferts
A 2018 graduate from the University of Nebraska-Kearney with a bachelor's degree in K-12 art education, Kameran works as an assistant educator for Nebraska 4-H Youth Development in Buffalo County. Kameran co-founded (and currently advises) the UNK chapter of The Diabetes Link. Professionally, Kameran focuses on programming in STE(A)M and youth entrepreneurship – focusing on the importance of creativity and the process of design in these fields. One of Kameran's favorite pieces of technology that she shares with her students is her continuous glucose monitor, which makes her "part-robot." In her spare time, Kameran also volunteers with the local diabetes camp, Camp Floyd Rogers, and the Nebraska and Southwest Iowa chapter of JDRF. She enjoys connecting with the diabetes online community through her Instagram page: @kamahkazee.

I’m sitting on a small stool at my desk in my home office (my bedroom), wearing a dressy top and sweatpants, anxiously waiting for my Zoom call to start. My palms are sweaty, and I’ve nervously checked my Dexcom readings three times in the last five minutes. Professionally, I have worked with these calls daily since January of 2019. One might be wondering why this call is any different. This time, I was speaking with my PA-C care provider, whom I typically drive three hours to see in-person every six months.

What is a PA-C? A physician assistant-certified (PA-C) is a graduate of an accredited physician assistant educational program. Instead of seeing an endocrinologist regularly, I see a PA-C at a specialized diabetes, endocrinology, and metabolism medical center. Although I have seen an endo at this Medical Center previously, I met with this specific PA-C once and immediately created a strong personal connection with her.

“I feel incredibly grateful that I have the means to meet with her via telehealth. I also feel incredibly grateful for my medical devices that made this appointment possible.”

Quite frankly, I was pretty sad that I wouldn’t get to see her in person due to the COVID19 pandemic. On the other hand, I feel incredibly grateful that I have the means to meet with her via telehealth. I also feel incredibly grateful for my medical devices that made this appointment possible. Reports from my InPen (the only smart insulin pen system that tracks active insulin via an app on your smart device) and my Dexcom (continuous glucose monitor) gave the PA-C adequate data to inform any adjustments to my routine/care plan.

The information from my two devices was enough for the PA-C to decide that we could totally bypass the A1c test this time around, “if [I was] okay with that.” After ten years living with type 1, I wanted to scream from the rooftops, “YES, I’M OKAY WITH THAT!” This was especially exciting for me, as I live in a smaller city (population ~30,000) and would have had to go to a lab to get my blood drawn to get an A1c test.

Since I wore my Dexcom for nearly 90 days straight and had data from my InPen for 90 days straight, she used the collective data to help me institute a couple changes to my care routine.

One of the many amazing things about the InPen is that the reports link up to my Dexcom! I’ve been enjoying using the InPen for almost two years now, and this is one of my favorite features (as I am a self-proclaimed diabetes data geek)! When the InPen “report” downloaded on my phone, I emailed it directly to the PA-C. The report downloads 14 days of graphs. The graphs show when different amounts of doses of insulin were taken with the InPen, the point at which it peaks, and when it is done working. The graphs also shows when/if glucose values or carbohydrates are manually entered into the InPen app.

Another exciting feature about the InPen is the dose calculator. By knowing your therapy setting (insulin-to-carb ratios, insulin sensitivity factors, duration of insulin action, etc.), the app can calculate exactly how much insulin you should take based on your current glucose levels, the carbohydrates you plan to eat, and any active insulin on board. Almost exactly like the way a pump operates, it calculates your insulin dose. The data points are especially important because the PA-C made an interesting discovery with the reports related to the dose calculator. She noticed that when the reports showed I used the dose calculator and followed the recommendations, my blood sugar levels seemed much more stable. She noticed that when there wasn’t a calculation reported, my blood sugars went for a roller coaster ride. This was either because of an estimation or a rage bolus! (Isn’t it crazy how sometimes we get into the habit of taking insulin without thinking?) Thanks to the reports, the PA-C was able to compassionately remind me about the importance of insulin calculations.

Due to the reports, she also suggested a change in my insulin sensitivity factors. Insulin sensitivity is one of those aspects of diabetes that I previously did not pay much attention. As better explained by Diatribe, “Insulin sensitivity factor or a ‘correction factor’ is how much one unit of insulin is expected to lower blood sugar. For example, if [one] unit of insulin will drop your blood sugar by 25 mg/dl, then your insulin sensitivity factor is 1:25. Different ISFs can be pre-programmed for different times of the day – e.g., many people are more insulin resistant in the morning, which requires a stronger correction factor.” Instead of changing my insulin-to-carb ratio (my initial assumption), we lowered my insulin sensitivity factor at 11:00am and 5:00pm due to high activity levels during those times of day. This has truly made all the difference in my ability to avoid having random hypos during the middle of the work day.

“I still left the appointment feeling so proud of myself for managing this disease with care and intention.”

A six-month checkup from my couch was unlike any similar diabetes appointment I’ve ever had! However, I still left the appointment feeling so proud of myself for managing this disease with care and intention. Since I have a PA-C on my care team who is knowledgeable, compassionate, and open-minded, I was able to successfully switch to MDI and receive an InPen. By using the InPen in conjunction with my Dexcom CGM, I have the confidence and freedom to manage my diabetes. For seven years, I thought I couldn’t live without a pump. Now, I have faith in myself and my abilities to manage my disease, discuss issues with my healthcare provider, and thrive overall in my everyday life!

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