Author: Frank

Diabetes Blogging 101.

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When I started writing here three and a half years ago, it was honestly more of a creative outlet to flex my Marketing and PR muscles. Diabetes sounded like something that I should write about, but I never, ever imagined that actual people with diabetes would be reading my blog.

Today, I think it’s fair to say that my blog has become a lot more than just a blog. I may or may not be classified as a diabetes social media junkie, an oversharer, a freelance writer, speaker, committee member, social networker, an advocate, a diabetes PR service or even a sellout to big pharma!

The diabetes community, both online and offline, has been invaluable to me. I am in a place with my own diabetes that I never imagined possible. I honestly owe it to every single individual that I’ve ever connected with, and every single piece of information I’ve ever been given. I wouldn’t trade being a part of the diabetes community for anything in the world (except maybe, a working pancreas…)

But at the same time, I get the impression that blogs are sometimes seen as merely something ‘nice’ to do. Or that a blogger is often pictured sitting in the comfort of their own home on a Monday morning, typing out a fresh post and then going about their leisurely day.

Blogging is a fairly big investment in the subject area you’re writing about and the cause you’re advocating for. Keeping on top of all of the news, developments, tools and technologies forms a pretty big part of my life. And hey, it also keeps me pretty motivated in wanting to better manage my own diabetes. I do not have a technical or scientific background. Yet as I hear myself talking enthusiastically to others, I realise just how much I have immersed myself into a very technical and scientific world.

There’s a pretty big investment of my own time. Whether it be writing my blog, taking part in advocacy work, responding to e-mails, networking or embarking on diabetes travel, it’s all done in my own time. Evenings. Weekends. Sometimes out of my hard earned annual leave. Often at relatively short notice for the responsibilities and full time job I’m leaving behind that pays for the pancreas that doesn’t work properly.

There’s also a pretty big responsibility in advocacy. When companies choose to speak to people with diabetes, I believe that’s a good thing. While some might see it as accepting tokens from ‘big pharma,’ I see it as a responsibility to tell them what’s important to people with diabetes. While trying to be mindful of my privilege.

I’d also be lying if I said that I didn’t feel a sense of obligation to the community that has given me so much. I know full well that I am a highly privileged person, and that I don’t represent all people with diabetes out there in the world. A mere four years ago, I was in a relatively isolated place with diabetes. I guess a big part of my ‘why’ is to help other people to discover the power of peer support and being engaged in the diabetes world.

For me, the biggest reward that has come from diabetes blogging is all of the amazing people I have met. My tribe of people who have diabetes feel like somewhat of a close knit family. I often arrive home after some amazing conversations with a cup that is overflowing and a newfound motivation.

Diabetes has made my world a lot smaller, and being part of this community always makes me feel that I am a part of something much, much bigger.

One of the occasional perks of diabetes travel…

YpsoPump: The First Few Weeks (Part Two)

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I’ve been road testing the new YpsoPump that launched in Australia last month. If you missed the first half of my review, you catch up here. 

I must admit that I was a little intimidated at the prospect of using Ypsomed’s Orbit inserter to place infusion sets on my stomach. When I last used the Animas insets two years ago, it was a terrifying experience. The insertion process with the disposable plastic insets were so clunky, leaving me with little confidence in whether my insertion was a success, or whether the cannula had kinked on the way in. I can still recall one tumultuous night where I didn’t pick up on a kinked cannula until several hours later when I had high blood sugars and moderate ketones.

Thankfully, I’m finding that the YpsoPump’s reusable Orbit inserter device does a far more efficient job. The plastic cannula that sits underneath the stomach feels much stronger than the Animas sets, which would also help with kinking as well. The infusion sets can also be inserted manually.

The area does feel a little tender after the pressure from the insertion, compared to the gentler manual Animas sets that I’ve been using. Thankfully, this hasn’t been a sign of any site failures. I’ve been cautiously doing my insertions 12-24 hours prior to switching the site, so that I’ll be able to pick up any signs of a site failure. I’ve had one bad site placement so far, and I was able to pick it up straight away (it was just a bit of blood).

I really like that if you do happen to place your site badly, you can simply clip it back onto the Orbit inserter and try again, compared to an inset which is rendered useless once it comes away from the insertion device. It’s also nice to have a reusable inserter device that doesn’t create so much plastic waste like the disposable insets.

Ypsomed’s Orbit infusion sets are cleverly designed to rotate 360 degrees. The end of the pump line clips into place over the top of the infusion site, rather than having to be clipped rigidly into the side of a set.

The downside to this design is that it is challenging to check the skin where the infusion set is placed for any signs of bruising and bleeding. I’m slowly getting used to seeing through the purple coating, with a little help from my iPhone torch.

The sets seem to stick well enough at the centre, although they do tend to come loose around the edges after showers. One thing I am enjoying is less sticky residue left on my skin after removing an infusion site.

There is a choice of Orbitsoft plastic infusion sets (6mm and 9mm) and Orbitmicro steel infusion sets (5.5mm and 8.5mm), with each available in lengths of 45cm, 60cm, 80cm and 110cm. I did try one of the steel sets, but I think I am a bit weirded out by having a needle permanently underneath my skin. While it worked just fine for three straight days, I can’t say that it was as comfortable as the plastic.

Ypsomed’s glass reservoirs hold 1.6ml of insulin, which is slightly less than the 2ml capacity of Animas and may be a consideration for people on larger insulin doses. We were told that insulin in the glass reservoirs could be used in the YpsoPump for up to 7 days, or stored in the fridge for 30 days.

I was also in disbelief as the pump continued to run for up to five minutes while I was changing the battery. There’s no more having to rewind and re prime the insulin cartridge, or worry about losing information about insulin on board. Since I stopped syncing with the mylife app and switched off the pump’s Bluetooth last week, I’m expecting to get around 3 weeks from the AAA alkaline battery.

When I caught up with one of the Ypsomed reps in Perth last week, I expressed just how much I want to hear from other people who have used new diabetes tools and technologies. Even during the pilot phase when I had no idea that I would be getting a pump, Ashley’s insights were so valuable.

People with diabetes need to be part of the conversation, and I’m super grateful that Ypsomed included us in their launch – which is especially generous considering they are relatively new to Australia.

The YpsoPump is available in Australia now. Subsidised consumables are available through the NDSS, although I’ve been told to expect a 7 to 10 day delay as my Pharmacy’s supplier doesn’t carry them. Which is understandable, given it’s a new product and the demand probably isn’t there yet.

A large group of Diabetes Educators attended pump training in Sydney last month, and Ypsomed has also been travelling around to various clinics around the country to train further healthcare professionals. So if you would like to get started on this pump, I am confident that you will be able to find a trained healthcare professional near you.

According to CDE Amy Rush of the Telethon Type 1 Family Centre in Perth, you may be able to get a YpsoPump before your pump replacement is due and Ypsomed will liaise directly with your health fund. I don’t know the details personally, but you can watch Amy’s video here.

If you haven’t already noticed the enthusiasm in this post, I genuinely am still brimming with enthusiasm for this pump four weeks in. I think the size, weight and sleekness of this pump are the real selling points for me.

After the pump complacency and health insurance issues that I’ve dealt with recently, the YpsoPump could not have come along at a more perfect time to help me feel re-energised in the daily grind. I officially ordered a second box of infusion sets last week, and am feeling quite optimistic about our future together.

YpsoPump: The First Few Weeks (Part One)

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I’ve been staring at my chunky old Animas Vibe with its holes in the coating and an interface from the ‘90s, thinking about how I will possibly be able to while away another two years before its warranty is up. I’ve been dreaming up scenarios in my mind where new pump options would arrive on our shores and be rolled out to existing Animas customers sooner rather than later.

But I never, ever, really imagined that I would have one of these exciting new options in my hands so soon.

(This is the part where I tell you that Ypsomed Australia provided me with a YpsoPump and consumables to take home and trial. Followed by the part where I tell you that was no expectation that I would write, or even trial the pump itself. Followed by the part where I remind you that there’s a bias in place and that you should take my enthusiasm with a grain of salt).

I’ve been YpsoPumping for almost four weeks, and I am absolutely loving how sleek and light it is. When I started pumping insulin two years ago, I wanted it purely for the benefit on my blood sugars. I never thought that this sleekness was something that I could ever ask for, or want, in a pump.

It weighs eighty three grams, inclusive of a AAA alkaline battery and filled insulin cartridge. To put that into perspective, It’s about half the size of my wallet and a third of the size of my iPhone. Did I mention that it’s slimmer, too? I hardly notice it in my pocket when I’m lounging on the couch or in bed at night.

It’s also way quieter than my late Animas Vibe. I no longer hear the swish of insulin boluses being delivered. Or that little ‘tick’ every three minutes as the pump infuses basal insulin into my body.

The interface is made of up of predominantly symbols and numbers, rather than words, which definitely took some getting used to.

It also has a touch screen, which can only be switched on by pressing the button on the side of the pump. The main menu also has a three tap access code before you can go in and administer insulin.

Basal rates can be set in increments of 0.01 units per hour, which gives greater customisation than the 0.25 units on my late Animas. The biggest challenge for me is that they can only be set on the hour, rather than the half hour. So when I wake up at 6.30am, I can only set my elevated waking basal rate to run from either 5am or 6am, rather than my ideal time of 5.30am. I’ve been experimenting with some basal tweaks this week, and hopefully I’ll be able to work around this.

I’m also liking the vibrating reminders when my temporary basal rate is finished running. I tend to sleep over middle of the night alarms, but the pump has even woken me up during the night to let me know a temporary basal rate has finished running. It’s a really handy feature to have, reminding me to check my blood sugar and evaluate whether I need to run it for longer.

The biggest difference to my late Animas is that the YpsoPump does not contain a bolus calculator. That is contained in the companion mylife smartphone app. Or any other bolus calculating app, for that matter. So you would need to open your app, work out your bolus, and enter that number into your pump. The app then syncs with the pump via Bluetooth to obtain insulin data. At the launch event, we were told that the pump could eventually be controlled from the app.

I have no problem using a phone app to calculate insulin boluses. I’ve done it before when I’ve taken pump breaks. But I found it frustrating having to wait a good 15 seconds for the app to sync with my pump so that I could do a bolus calculation. I’m so used to being able to quickly glance at my insulin on board during the day before various activities. Not to mention that having my Bluetooth constantly switched on is a drain on both my pump and iPhone battery. As a result, I must say that I’ve been slacking off on bolus calculations.

I expressed to the rep last week that it would be helpful if the bolus calculator worked independently of having to sync with the pump. After suggesting that I could switch my insulin therapy settings to Multiple Daily Injections, I’ve been able to do just that. So long as I’m logging all of my bolus calculations and insulin doses in the app, I’ll be able to see my insulin on board without having to sync the pump via Bluetooth.

The pump can deliver insulin boluses in increments of 0.1 units, which is slightly less than the 0.05 my late Animas allowed. The bolus calculator automatically subtracts insulin on board from a bolus calculation, which might not always be necessary. It also lacks the flexibility to make adjustments to insulin to carb ratios or insulin sensitivity factors for things like physical activity. However, it is working a lot better for me in MDI mode.

I know just how hard a good bolus calculator is to find, and for me a diabetes app without one simply has no value. Ypsomed do appear to see the bigger picture of people who don’t use pumps and CGMs, and I’m confident that the company is working hard to make Multiple Daily Injections and glucose monitoring ‘smarter’ as well.

If you are looking for a bolus calculator, you can search for the ‘mylife app’ in your Google Play or App Store.

Come back tomorrow for part two of my review of the YpsoPump!

Updated: Find part 2 here!

Red Light.

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I glance at the watch on my wrist. I know that it will only take me a minute, but it’s 4 o’clock and I really want to get out of here already.

I make the trek outside, where my car is conveniently parked in its usual spot at the end closest to the centre door. It’s a longer walk in the morning, when I have to come in through the back entrance, but completely worth it at the end of the day.

I hop inside my car, and place my belongings on the vacant seat beside me. I know that it will only take me a minute, but I really just want to start making my way home where afternoon coffee is calling my name.

I place my keys in the ignition, lock my doors and wind down my windows. I reverse out of my spot and make my way out of the carpark, cutting through some of the quieter residential areas in order to avoid the pile up of traffic on my way out of the centre. I make one final right, which takes me back out onto the main road and in a far better position traffic wise.

Finally, I have what I’ve been waiting for as I begin to apply my brakes, slide my gears back into neutral and cars begin to bank up in front of me. A red light.

I only have a minute, but I know I can do it.

I dive into my bag, pull out my travel case and grab my meter, strips and lancing device. I quickly pop open the cap on my test strip vial and slide out a fresh strip, sticking it into my blood glucose meter. I prick my finger with the lancing device, and squeeze my fingertip. A little drop of blood appears on my fingertip, but I know its not enough. I squeeze again, harder, like I’m holding on tightly for dear life.

Part of me knows I don’t have enough blood, but the other hasty part of my brain watching the traffic light tells me I can do this. I bring the meter closer to my fingertip, and let the blood slide onto the end of the test strip.

A shrill BEEEEEEP! Sounds from my meter as a strip fill error appears on the screen. My absolute pet hate when it comes to living with diabetes.

I furiously rip out the useless test strip, pop open the cap on my vial of strips and slide out a new one. I stick it onto the end of my meter, shove my lancing device right up against the tip of my finger and prick again. This time, blood flows more freely. Satisfied, the test strip laps it up and decides to give me a blood glucose reading.

I quickly wipe the excess blood on my fingertip against the side of the test strip as the light changes to green and traffic begins to move. I fling everything on the passenger seat beside me, which I’ll clean up during the next red light.

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.