Month: September 2018

V-Go Insulin Pump Launches in Australia!

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Also launched alongside the t:slim x2 insulin pump at the Diabetes Congress last month was the V-Go disposable insulin delivery device. It’s been available in the US since 2012 through a company called Valeritas, and AMSL diabetes have signed on the dotted line to distribute this baby in Australia.

Designed for people with type 2 diabetes, this patch pump holds a 24 hour supply of rapid acting insulin. It delivers a fixed rate of basal in the same continuous fashion as a regular pump, and comes in three different sizes delivering 20, 30 and 40 units of basal insulin respectively. The basal rate cannot be adjusted, and the size you are prescribed will depend on your weight and insulin needs.

Each V-Go can also hold an additional 36 units for bolus insulin as needed. Boluses are delivered at the push of a button on the pump itself, with each click delivering 2 units of insulin. If you are on smaller doses of insulin, this pump may not be suitable for you.

The pump does need to be replaced daily, which could be a hindrance, although I don’t see why you couldn’t pre-fill a few days’ worth in advance. Any leftover bolus insulin in the V-Go at the end of the 24 hours cannot be reused, so bolus insulin needs are definitely something to be mindful of when pre-filling your V-Go.

Each V-Go is pre filled with insulin using an Ez-Fill device. The insulin delivery device slides in at the bottom, your insulin vial sits at the top and then insulin is pushed into the V-Go using the plunger. I am told that the Ez-Fill is designed for use with insulin vials only.

Once the device is filled, you simply stick the patch onto your skin. It’s approved for use in the arms, thighs, abdomen or legs. A press of the needle button on the surface will release the needle contained within the pump and commence the delivery of insulin. The needle retracts once you’re ready to remove the device.

The V-Go system is sold in a 30 day kit which contains 30 insulin delivery patches and an Ez Fill device. It does seem a little wasteful to include a new Ez Fill in every kit!

The V-Go is not currently subsidised through private health insurance here in Australia, meaning that users will have to bear all of the out of pocket costs. The 30 day kit retails for $250, which works out to approximately $8.30 per day. This is considerably more than both Multiple Daily Injections and the subsidised insulin pump consumables we have available to us through the NDSS. However, I do like that this would be easy to trial without a larger commitment if its not for you.

Overall I can see why this device might appeal to someone with type 2 diabetes, and also the older individuals who are modelling the device in the demo kit. It’s mechanical in nature and free from any programming. The application looks far easier than an infusion site. Click to bolus looks both easy and discreet. The demo kit also indicated that many people missed their insulin doses due to needles not fitting into their lifestyle.

The main criticism I have noted in forums is that this device may not be suitable for people with heavier insulin resistance and larger insulin doses. I was also unimpressed to read so much focus on ‘improved patient adherence’ throughout the demo kit. Language Matters!

I am told that people with diabetes are free to complete the V-Go order form which can be found on the AMSL diabetes website. However, users should go through their endocrinologist or diabetes educator to prescribe the basal and get set up.

As tempted as I am to trial the demo kit of my own that I received, the fixed basal rate won’t meet my needs as a type one. Although it was suggested that I try it next time I have a pizza night! I also enquired as to whether there was a way to use it for bolus insulin only, but unfortunately there is no way to stop the flow of basal insulin once the needle is released.

Overall, I think it’s great to see more options to meet the needs of all people with diabetes. I really do hope that AMSL will try to involve some people with type 2 diabetes in the launch of this product, as they would be better equipped to talk about it than I am.

Disclosures: Diabetes Australia covered my travel, accommodation and registration costs to attend the Australasian Diabetes Congress. These are my own views, and not those of Diabetes Australia.

AMSL Diabetes hosted me at a bloggers evening during the ADC, which was primarily focussed on the t:slim insulin pump. I was fed and watered across the duration of that evening and received a small bag of stationery.

I later visited the AMSL booth in the Exhibition Hall to learn more about the V-Go, where I was given a demo kit of my own to take home. I was not asked to blog about AMSL or the V-Go. My opinions and my time, including the annual leave I took to attend the ADC, are my own.

Dressing for Diabetes

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Most of the time my insulin pump sits clipped safely inside the left pocket of my track pants, pyjama bottoms, jeans or shorts. I’m pretty grateful that pockets are the norm in most of the clothes that I purchase these days.

I’ve tried clipping my pump to my waistband, but to be honest it just doesn’t feel comfortable there. It’s harder to reach, more work to put back and easier to knock into things.

Most of the time, my insulin pump doesn’t bother me inside my left pocket.

Until I get dressed for work, and tuck my business shirt into my trousers.

Then, my insulin pump definitely bothers me.

I don’t particularly like seeing my pump line protruding from my waistline all the way to my left pocket. I don’t enjoy having to rein my line back in through the day as it comes loose from constant movement. I hate having to navigate my iPhone around my pump line every time that I dive into my left pocket to reach for it.

The other morning as I was getting dressed for work, I could really feel the frustration.

In a moment of diabetes randomness, I pulled my insulin pump band out from inside my diabetes junk drawer. I pulled the blue band over my head and shoulders, pulled my arms over and settled it low around my waist until it finally started to feel comfy.

I grabbed my pump and concealed it inside the pockets of my blue waistband, shuffling it around on my waist trying to find somewhat of a comfy spot. I finally settled just past my left hip, heading closer towards my back. After a bit of fidgeting, I tucked my shirt in and it didn’t feel all that bad.

An hour later I was at work, moving around. I could feel my pump band shifting away from my comfy low zone and slowly creeping up my waist. I could feel myself going low, instantly regretting the 1 unit I had given myself for the eggs I’d eaten for breakfast.

As I walked back to my desk and popped open my jar of glucose tabs, I remembered exactly why I’d never done this before. As I instinctively reached for my pump to check how much insulin I had on board, I was reminded why I liked having my pump clipped in my left pocket rather than anywhere else.

Some days I glance at my pump in the mirror while getting dressed and feel so comfortable having it there to help better manage my blood sugars for me.

Other days I feel dirty, weighted down and different for having it there.

The size of diabetes devices really do make a difference to my mindset and quality of my life.

For the time being, it’s just something that I’ll have to learn to live with.

In an Ideal World

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I originally wrote this post some time ago, but the words couldn’t ring truer, particularly when I think about my own blood sugars this weekend.

***

In an ideal world, my meter would produce a magical 5.5 while I’m fasting.

In an ideal world, I could select any spot on my stomach for the placement of an infusion site.

In an ideal world, my blood sugars would respond to potatoes in exactly the same fashion as yoghurt.

In an ideal world, I could fall asleep knowing that my blood sugar will stay stable all through the night.

In an ideal world, I could go for a walk and not worry about my blood sugar dropping.

In an ideal world, I wouldn’t have to worry about rage bolusing every time I’m sick or I’m stressed.

In an ideal world, my levels would steadily rise and then fall back into line after I eat.

In an ideal world, my blood sugar wouldn’t be affected by protein or fat.

In an ideal world, I would be able to feel every oncoming hypo.

In an ideal world, my basal insulin needs would be identical through each hour of the day and the night.

In an ideal world, a diabetes healthcare professional would spend a whole day with me if need be.

In an ideal world, I would have been encouraged to consider technology by my diabetes team.

In an ideal world, everyone who wishes to use an insulin pump would have one.

In an ideal world, a Continuous Glucose Monitor would be subsidised for those who want to use one.

In an ideal world, insulin wouldn’t be so fucking expensive.

In an ideal world, insulin wouldn’t keep getting more fucking expensive.

In an ideal world, access to medication and basic healthcare wouldn’t be determined by my location or income.

In an ideal world, diabetes and pharmaceutical companies would have the best interests of people living with diabetes at heart.

In an ideal world, I would be excited about the artificial pancreas systems hitting the market next year.

In an ideal world, nobody would feel isolated or different for having diabetes.

In an ideal world, I would have perfect management of my diabetes.

Review: FreeStyle Insulinx Blood Glucose Meter

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This week, I’m on a mission to deplete my remaining supply of FreeStyle Lite test strips. My calculations tell me that they should be depleted by early Thursday. The one piece of motivation that’s getting me through these final days is the mental promise of a new FreeStyle Libre sensor at the end of it. As part of this final hurrah, I thought I’d take the opportunity to celebrate the ‘life’ of my FreeStyle Insulinx meter over the past two and a half years.

I was first given an Insulinx back in 2015 after I had reconnected with my diabetes educator to discuss insulin pumping. This was a meter with a built in bolus calculator that would help me to become familiar with counting carbohydrates, which is what I’d eventually have to do on an insulin pump.

I had been using the same blood glucose meter since the day I was diagnosed. I didn’t know too much about diabetes back then, or some of the more ‘modern’ options that were on the market. Or the fact that ‘free’ meters were so easy to come across, because companies actually make money from the test strips!

The Insulinx was my first ‘modern’ glucose meter. I loved the test strips that were conveniently stored in capped vials, rather than being wrapped in foil. The USB cable, which meant that I was able to upload the data to my computer for review. There was a backlight for testing in the dark. It also used a much smaller sample of blood, and gave you an additional 60 seconds to apply more blood. No more annoying strip fill errors!

As much as I welcomed these modern features, I didn’t really make much use of the bolus calculator function. Mostly because I wasn’t motivated to count carbs and log insulin doses at the time.

Fast forward to today where I’ve tried many more meters and am generally more switched on to what my blood glucose levels are doing, the FreeStyle Insulinx simply does not meet my needs anymore.

The ‘Lite’ test strips may require a smaller sample of blood (0.3uL), however I feel that it’s easier for any sweat or moisture on my fingers to affect the blood glucose reading. I’ve been trying to combat this by extracting a larger drop of blood from my finger and making more of an effort to wash my hands prior to testing. I also don’t like not being able to physically ‘see’ the blood going onto the strip like other meters do.

The bolus calculator on the Insulinx isn’t as comprehensive as the one you might find on a pump or smartphone apps such as RapidCalc. Little things like being able to adjust carb ratios while I’m on my feet at work are a big deal for me. During pump breaks and even while using the YpsoPump, I haven’t even considered the bolus calculator that’s contained inside my Insulinx.

All of these gripes aside, I simply haven’t found the results to be as consistent or as trustworthy as my AccuChek Guide. Just last week I had something like a 12.7, a 10.1 and then an 11.6 in a row with clean fingers. Alternatively my AccuChek Guide has chalked up impressive consistency, even when throwing some grubby work fingers into the mix!

Due to its bolus calculating capabilities, the FreeStyle Insulinx is only available from a healthcare professional. If you’re using a FreeStyle Libre, the same bolus calculator is also built into the reader. Just make sure to ask for the code to unlock the bolus calculator.

I’m mindful that I’m a huge adopter of diabetes technology. Perhaps that’s why I’ve gravitated towards wireless systems such as Contour Next One or AccuChek Guide that will sync readings to my iPhone via Bluetooth for instant review.

For people who do want something simple and may not have the latest whiz-bang smartphone, this could be the perfect option for you.

Headspace.

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Diabetes is an extremely isolating condition to live with. Those around me might often see the click of a lancet, the prime of a needle or the hit of a button on my insulin pump. You know what? That’s about it. To the outside world, there’s not a lot more to living with diabetes.

People don’t see the wave of emotions that often accompany the numbers that show up on the meter. People don’t see the immense mathematics and thought processes that go into the hit of those buttons on the insulin pump. People don’t see the physical depletion that comes from managing diabetes 24 hours a day, while trying to live a full life that is sometimes challenging in itself.

I’d be lying if I said that diabetes hasn’t messed with my headspace on several occasions. I’ve had days where I’ve come home feeling absolutely depleted, overwhelmed and not in a great frame of mind. Times that have always signalled to me that I need some time out to reset.

Self care has become a pretty big part of keeping myself in a good headspace with diabetes. It’s often the smallest, simplest and most selfish of acts that have the greatest impact.

I often post images of mysterious landscapes to my Instagram, and there’s a good reason why. Getting outdoors and going for a walk in the afternoons works wonders on my mindset. Things like hearing the sound of my feet hitting the pavement, feeling the chilly air on my face, or marvelling at the evening sky and surrounds helps clear my head at the end of a long day.

Food is definitely another act of self care, that I’m really working extra hard at right now. I’ve been forcing myself out of bed half an hour earlier each morning so that I have the time to prepare myself a more substantial breakfast, rather than eating a slice of toast and then feeling utterly exhausted and unable to concentrate for the remainder of the morning.

I’d also be remiss not to mention peer support here as well. Diabetes has brought so many amazing people into my life, and it really does make me wonder how I used to manage without them. I get so much out of simply talking to other people like me, and knowing that I am not alone in what I’m dealing with.

While I can’t actually stop managing my diabetes, I can choose only to do the bare minimum while placing the remainder of it on the backburner. I can log out of all of my social media handles for a day or two, settle in on the couch and binge watch a favourite TV show, open a book or go to bed a little earlier than normal. That too, is all okay.

I absolutely hate the insincere ‘how are you’ that is often exchanged in passing, or over the phone with acquaintances. Along with the reply of ‘fine thanks’ that is expected in return, often not until these two passing ships are long behind each other. For me personally, a ‘hello’ in return will suffice.

Today is R U OK Day, and the idea is to engage with those around us in a meaningful way. Living with diabetes makes us even more prone to facing mental or emotional issues, and talking about these issues often makes them easier to deal with.

Perhaps one way that we could do this is by using the words ‘how are you’ when we actually mean them, and have the time to listen to the answer in return.