Month: June 2018

Perspectives on Pumping.

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I recently had a student reach out to me for insight on a research project titled ‘Positive and Negative Social Impacts of Insulin Pumping.’ I really, really loved these questions. I was never asked how diabetes made me feel after my diagnosis. I got a pump because I felt like it was my last chance to gain some control over my blood sugars. I never really thought about how a pump would make me feel. 

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Did you ever feel excluded or underestimated because of diabetes? Was this also impacted based on the treatment you use?

Being diagnosed with type 1 at the age of 17, I had lived all of my life to that point without diabetes. Naturally, I felt very conscious of ‘introducing’ and managing my new condition around others.

Diabetes also felt extremely isolating. I didn’t know a single other person with type 1. Management tasks like checking blood sugar levels and calculating insulin doses were largely invisible to those around me. It was difficult to lean on my loved ones for support, as I didn’t feel that they would be able to completely understand the complex nature of this condition.

To answer your question, I don’t think that these feelings would be any different with either pens or a pump. It’s the diabetes itself!

Did the insulin pump change your lifestyle or encourage you to start new habits? 

The insulin pump definitely motivated me to start counting carbohydrates, rather than guessing my insulin doses. I started paying more attention to my diabetes and learned how to better respond to many of the different factors that affected blood sugars. And, of course, it offered an element of convenience in my insulin dosing over needles. The variance in my blood sugars improved a lot within a few months of pump therapy.

I also found that the insulin pump produced more low blood sugars during exercise than injections ever did. Having rapid acting insulin as my basal, rather than a long acting insulin used with injections, made it easier to go low while I was on my feet at work or doing housework at home. Physical activity with a pump requires a lot more planning, which for me is a little discouraging if I feel like going for a spontaneous afternoon walk around the block.

Has diabetes inspired or motivated you to join different groups? Has it, generally speaking of social impacts, improved your life?

Absolutely! Although, I don’t think I would have been keen on meeting other people with diabetes in the initial years after my diagnosis.

I began using Twitter with more of a diabetes focus when I started my blog in 2015, which connected me to a vibrant online community of people with diabetes from all over the world. This community was so valuable to me, and eventually motivated me get out and meet other people with diabetes.

Diabetes has given me a lot of confidence in regards to being more open about my condition, and I’d like to think that this confidence has extended beyond just my diabetes. Peer support has definitely improved my mental wellbeing. Diabetes is such an isolating condition to live with, and having peers to talk to and laugh with are a constant reminder that I am not alone in this.

How flexible are you with the insulin pump?

The pump will give you more flexibility if you’re prepared to put the hard work in.

For me, the pump has offered me the most flexibility in being able to customise basal insulin to the time of day. For example, being able to deliver a higher rate of basal insulin in the early hours in the morning to combat what is known as dawn phenomenon – a surge of hormones that triggers the liver to dump additional glucose into the bloodstream.

But again, the pump is only as smart as the person pressing the buttons. In this example, I’ve had to make the commitment to monitoring my blood sugars, identifying trends and making adjustments to my basal rates accordingly.

Does the changing of the cannula take a lot of time and patience?

It was definitely a learning curve in the beginning. I had to make sure that I didn’t pick an overused spot on the stomach that could bruise or bleed, that the cannula didn’t kink on the way in, and that there weren’t any air bubbles in my pump line that could impair insulin delivery. Site changes did create a little anxiety in the beginning. If it wasn’t successful and I wasn’t getting my insulin, my blood sugar would go high pretty quickly and I could be in Diabetic Ketoacidosis within a few hours.

Today, it’s just another ‘chore’ that I have to stop and get around to doing every three days.

Any additional positive or negative impacts of the treatment on the social aspect?

I’m pretty neutral on this. The pump does make things more convenient in social settings and when I’m on the go. It’s worth noting that lots of people dislike needles, so the pump is a big help there. But there’s also a lot of maintenance you need to keep on top of and more consumables you need to keep handy, so it depends on how you look at it!

I feel it’s the nature of diabetes as a whole, rather than a particular insulin therapy, that may have an influence on social aspects of life. I feel its more important that people with diabetes receive adequate support to accept their condition and live well with diabetes – from their healthcare professionals, peers, loved ones and even mental health professionals.

The YpsoPump Launch Event

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My first week with the YpsoPump saw me in holiday eat-and-bolus-without-really-thinking-too-much-about-diabetes mode. Not to mention that it was my return to insulin pumping following a month long break. Week two saw me back at home with one of the worst Winter colds I’ve had in years and some of the craziest insulin resistance I’ve seen. It’s now week three and I’m just beginning to return to some sense of normality with the ‘betes.

Safe to say, I feel as though I’ve already been through a lot with this pump in the short time we’ve known each other. I really am enjoying the YpsoPump for its sleekness and light weight nature, and you can also check out my Instagram stories for more insight here. I’ll have some more to share here soon, I just don’t think I can fairly review a pump without using it for a good few weeks.

I had never even heard of the YpsoPump prior to searching the TGA website earlier this year in desperation for any signs of new insulin pump choices following the demise of Animas. I then noticed fellow blogger Ashley of Bittersweet Diagnosis had been trialling the YpsoPump, indicating that an Australian launch was on the horizon. A bit later on, I was fortunate enough to receive my own invitation to a launch event held in Sydney three weeks ago.

We were introduced to a Swiss company called Ypsomed (pronounced “Ipsomed”). As a manufacturer of tailor made insulin injection pens and autoinjectors, the company vision is to make self care simpler and easier. We were told that the company had a long, successful history of insulin pumps in the world, dating back to 1985. The YpsoPump had been designed to fill the gap in a market filled with complex, medical looking devices.

Ypsomed’s portfolio of diabetes products fall under the company’s Mylife Diabetescare brand. Encouragingly, their portfolio extended to people on Multiple Daily Injections and structured blood glucose monitoring. Products included clickfine needles, lancets, injection pens and a new Unio Neva blood glucose monitor using a custom brand of test strips. Not to mention that YpsoPump’s companion ‘Mylife’ smartphone app would also be useful to people not on a pump (it’s a free download from your App or Google Play store).

We were shown a roadmap of future upgrades to the YpsoPump system. This included the addition of the Unio Neva blood glucose meter that would send blood glucose readings to the Mylife smartphone app via Bluetooth. Ypsomed are also in discussions with manufacturers to add CGM integration into the pump. The YpsoPump will eventually be able to be controlled remotely via the smartphone app, but this looks to be at least 12-18 months away.

Ypsomed is also manufacturer of the wildly popular Omnipod tubeless insulin pump, which received TGA approval some time ago but has not yet managed to surface. The NDSS funds insulin pump consumables here in Australia, while private health insurers fund the actual device. Ypsomed have not been able to find a way to fit the funding model here in Australia due to the disposable nature of the Omnipod.

In response, we were told that a smaller ‘YpsoPod’ is currently in development with an expected 2021/22 completion. One half is disposable while one half is durable, meaning that this pump would fit the funding model in Australia.

Everything sounded really encouraging, with Ypsomed assuring us that they are here to stay and committed to the Australian market. This includes a dedicated Australian based customer service team. I’m also looking forward to catching up with a member of the Ypsomed team visiting Perth this week.

At the end of the day, more choice for people with diabetes is always a good thing. A massive thank you to Ypsomed Australia for having people with diabetes there.

Disclosures: Ypsomed Australia covered my travel and accommodation expenses to attend the launch event in Sydney. I was fed and watered across the duration of the event. I also received a YpsoPump and consumables to take home and trial. There was no expectation that I would blog about Ypsomed or the YpsoPump. My opinions and my time, including the annual leave I took from work to attend, are my own.

Ten Things I Wish I Knew About Being Sick With Diabetes

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I wish someone had told me that infections trigger the liver to dump additional glucose into my bloodstream. Then I may not have felt so frustrated over high blood glucose levels.

I wish someone had told me to increase my long acting insulin dose to combat the sick day insulin resistance. Then I may not have gone stir crazy when my levels wouldn’t budge despite correction after correction.

I wish someone had told me that work would be able to survive without me for a day. Then I wouldn’t feel riddled with guilt for spreading my germs over keys and pens and phones. Or live to regret the miserable sight that I am to be around when unwell.

I wish someone had told me that a statutory declaration is sufficient evidence for not being present at school or exams or at work. Then I may have saved myself a few unnecessary trips to the doctor.

I wish someone had told me that putting the Vicks under my nostrils before bed might just help to relive my congestion. Then I wouldn’t be left tossing and turning through the night, plagued with blocked nostrils and piles of wet tissues.

I wish someone had told me that keeping hydrated might just help manage high blood glucose levels. Then I might not end up sculling fluids down when I’m on the borderline of ketones.

I wish someone had told me to get into a habit of washing my hands after coming into contact with others, and especially before food. Then I might not find myself off sick all that often.

I wish someone had told me that I could treat my hypos with juice. Then I wouldn’t be forced to endure jellybeans on a sore, bone dry throat. Or have to worry about keeping my hypo food down.

I wish someone had told me that it’s okay to sleep. Stay in pyjamas, watch Netflix or comfort eat.

I wish someone had told me that I’d weather the storm. The high blood glucose levels, the misery and everything far from the norm.

Hypo in the Diabetes Clinic.

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“Are you still using the Animas?”

“Actually, I have the new YpsoPump.” I replied to the nurse, pulling it out of my pocket.

“Would you like to use your own lancet?”

“Good idea,” I replied, pulling it out of my pencil case and avoiding a bloodbath on my fingers.

“Oh, you’re 3.8,” the nurse said to me after I had applied some blood onto the test strip. “Have you got some hypo treatment on you?”

Before I was even given any time to answer, she had poured me a glass of sugary fluid to drink and handed it to me. Encouragingly, it was an appropriate sized amount that wouldn’t send me rebounding.

“Are you able to feel your hypos?”

“If it’s a steady 3.8, like this one, I feel fine. But if it were a 3.8 and dropping rapidly, I would.” She was lovely, and I didn’t feel that I was being judged.

Another nurse walked in, also wanting to have a look at my new YpsoPump. “Of course, you should treat your hypo first!” She exclaimed to me in a motherly way, after being reminded by nurse one that I was hypo.

“Are you sure I can’t get you some biscuits or anything?” the nurse asked me, as I made my way towards the door.

“No, I’ll be fine. The tea will probably bring me up as well,” I said as I grabbed the Styrofoam cup that I had been given in the hallway earlier.

I made my way back toward the end of the corridor, took a seat and buried my head into my iPhone, grateful for the warm drink on my sore throat. I wasn’t worried.

Some time later, the nurse returned. She hovered for a moment, but I didn’t really notice until she spoke.

“Frank, would you like to check your blood sugar again?”

Knowing it had been sufficiently treated, I had completely forgotten about my hypo. I pulled out my FreeStyle Libre, registering the 3.7. I wasn’t convinced that I needed anything further, and pulled out my meter.

“I’m happy to leave it,” I said, holding up my meter that was displaying a 4.4. “I don’t want to overtreat it, and the tea will probably bring me up a bit more as well.”

“Are you sure I can’t get you any biscuits or something?”

“No, I’m fine. Thank you.”

I get that this comes from a good place. A really good place.

Perhaps if hypos hadn’t interrupted many of my work days, bed times, socialising, housework, walks and errands over the years, I might just treat them with the same response as that nurse.

Hypos are not a scary thing, provided I know how to manage them. They are a part of living with diabetes, just like checking my blood sugar or injecting some insulin. Last year at the Roche Educator’s Day, I made a big point of stating that two hypos per week was an unrealistic expectation from my healthcare professionals. Moreso as my skills in managing blood sugars improved and I was spending more time in range.

I get that hypos are not good for me in the long run. I get that hypos can impair my cognitive function. I also get that hypos can be life threatening – and maybe I’m just lucky that I’ve never had one where I’ve needed help. Believe me, I don’t like having hypos anymore than a healthcare professional likes seeing them appear on a blood glucose meter.

However I feel it’s more important that I’m dosing insulin responsibly, checking my blood sugar often enough, travelling with glucose tabs on hand and am able to sufficiently treat a low.

Some healthcare professionals condemn people with diabetes for having too many lows, and this is where we need to reshape our attitudes toward hypos.

Making me feel any lesser for the number of hypos I have will only make it more difficult for me to share openly in front of a healthcare professional, ultimately jeopardising the provision of any support I may need.

FreeStyle LibreLink: First Impressions!

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I must admit that I couldn’t get too excited at the news of FreeStyle LibreLink hitting our shoes Down Under. However I was really blown away by the response to my vlog last week, which suggests that perhaps I am in the minority on this new smartphone app.

FreeStyle LibreLink is a smartphone app that can either complement or replace the fundamental role of a FreeStyle Libre reader. So if you are thinking about trialling or getting started with a FreeStyle Libre system, you will no longer need to invest in a $95 reader. I also thought that LibreLink may be advantageous to parents or loved ones, who could have their own access to the data provided they scan the sensor with their respective devices (devices don’t share data).

Abbott told us that while LibreLink was originally due in August, they have fast tracked the launch as a show of their commitment to get their technology into the hands of as many people as possible.

The FreeStyle Libre system utilises Near Field Communication (NFC) technology in order to scan the sensor and obtain a blood glucose reading. In order to use the FreeStyle LibreLink app, your phone must have these same NFC capabilities as the FreeStyle Libre system, and this is the reason for limitations on compatible phone models.

So, blame Apple. Or Samsung. Or whoever else you feel like blaming.

Apple users will need an iPhone 7 or higher, running on iOS 11 or higher. Android users will need a phone with NFC, running on Android 5.0 (Lollipop) or higher.

If you wish to use your reader in conjunction with the LibreLink app, you must activate a new FreeStyle Libre sensor with your reader, followed by the LibreLink app during the 60 minute warmup period. If you do not activate with both devices during the warmup period, then you will only be able to read data with the one device you activated with.

Why can LibreLink only be used with a new sensor, and not an existing one? I am told this is purely for security reasons, otherwise I could theoretically approach anyone wearing a sensor and scan it.

My loaner iPhone seemed to scan my FreeStyle Libre sensor just as well as my reader did. A reading is best taken by pointing the top end of your iPhone, where your ear rests, over the sensor.

One noteworthy feature is the text to voice, which will voice your blood glucose level and trend following a scan. This may prove useful when you’re in bed and don’t want to open your eyes, or if you’re wanting to interrupt someone else’s presentation and show off your reading of 6.6 and steady to the rest of the group (sorry, Kim!).

I also think that the app will be really valuable for accessing blood glucose reports without the need to upload to a computer. I must admit I can’t remember the last time I uploaded my pump or my meters to the computer. In the whole scope of managing diabetes, little tasks like these often slip and features like this really do make a big difference.

LibreLink does not have the capability to transmit blood glucose data to another device. Nor can data be shared between a phone and a reader. You know how you can click on that little forward button when browsing your iPhone to share a link or a photo? That’s basically how you can share things like screenshots or reports from inside the LibreLink app with others.

Everything else that you’re used to seeing in the reader is there, with a bit of an expanded view.

      

Also on the horizon is Libreview, a cloud based software designed as a companion to LibreLink that provides a way to share data with healthcare professionals.

I don’t have any plans to upgrade my old iPhone 6 anytime soon to use the LibreLink at home. I’m also not sure that I view carrying my Libre reader around as a hassle. Having my iPhone on me all the time can be equally distracting. Another reservation I have is the increased demand placed on my iPhone’s resources from the introduction of two new mobile apps in the space of a week (YpsoPump app and LibreLink).

That being said, I have definitely underestimated LibreLink. It’s fantastic that FreeStyle Libre users will have more ways to access and engage with their blood glucose data. More choice for people with diabetes is always a good thing.

The FreeStyle LibreLink app launches in Australia tomorrow, and is available as a free download from your Apple or Google Play store on a compatible device.

Disclosures: Abbott Diabetes Care covered my travel and accommodation costs to attend DX2Sydney. I was fed and watered across the duration of the event. I was also provided with a FreeStyle Libre sensor and a loaner phone if I wished to trial the FreeStyle LibreLink app during the event. There was no expectation that I would blog about anything covered at the event. My opinions and my time, including the annual leave I took from work to be there, are my own.