Author: Frank

Dear Pancreas

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Dear Pancreas,

Congratulations. You’ve officially been in retirement for eight years today. I hope you’ve enjoyed the seemingly endless stretch of long sleep ins and lazy, effortless days.

If there’s one organ in the human body that I’ve truly come to appreciate since you clocked off for the last time eight years ago, it would have to be you.

You were able to produce just the right amount of insulin for the carbohydrates that I sent your way, and convert those carbs into energy for me to use through the day.

You were able to respond to all of the crazy factors that affected my blood sugars. Things like pizza nights, illness, stress, physical activity and even how well I slept last night!

You were able to produce just the right amount of insulin so that my blood sugar didn’t peak too high, but also didn’t drop dangerously low. You never had to chase the unicorns.

I honestly don’t know how you did that gig all by yourself for 17 years. You didn’t have any resources at your disposal. You didn’t have any healthcare professionals to guide you. You didn’t even have any friends to support you. Yet you never once complained.

Being a pancreas is in no way normal. There’s no one else quite like you. The nature of your job can feel rather isolating. Yet you held your head up high. You stood tall. You never once showed a single shred of emotion. You never burned out.

You’ve definitely pushed me far from my comfort zone. I’ve met new people, I’ve visited new places. Your retirement has definitely instilled a great deal more confidence in me than I’d ever once imagined.

Dare I say I’ve taken quite an interest in you. I read about you. I talk about you. I write about you, frequently. I’ve even dedicated a whole blog to your demise. Some might say I’m obsessed with you.

You’ve left me with tonnes of additional duties since you departed the office eight years ago. I’m ashamed to admit that I don’t do the job half as well as you once did. I have to do the job of a human being as well, you know. I do try my best, you know, but somehow I don’t think I’ll ever be able to fill your shoes.

So, in case you had forgotten, today also happens to be my eighth diaversary. I’m not sure if you’ve been out shopping yet, but if you wanted to get me something really nice to mark the occasion, you could simply get up off the couch and come out of retirement.

I know I can’t offer you much, but I promise to feed you, take care of you and provide a roof over your head. I’ll never for a second take your job for granted again.

So, what do you say?

With all my love,

Frank

Breaking Up With My Health Insurer.

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When a loyal customer informs you that they will be taking their business elsewhere for sake of better value for money, you would think that the appropriate response would be to do everything possible to convince you to stay.

When I walked into my local HBF branch on Friday to do just that, the member service advisor (who actually had a connection to diabetes) simply told me that she completely understood.

I’d be lying if I said that I don’t feel a little stung by the health insurer that my family have been loyal to for as long as I can remember. I can remember impatiently waiting at the HBF branch at Karrinyup on many occasions as a kid when my parents had claims issues to deal with. When my Mum and Dad brought me to HBF after I first commenced full time work to take out a policy of my own, I did not even think about choosing anyone else to look after my health.

I genuinely liked that HBF were a West Australian business, with a family feel to it. There were plenty of local branches nearby where I could go and talk to an actual person, rather than deal with a matter over the phone with the call centre on the East Coast. We haven’t ever had a problem with them over the years.

However along with insulin pumps, HBF no longer covers dialysis, cochlear implants and surgical weight loss procedures on basic tier hospital policies. Meanwhile, I can receive claims or discounts for ‘wellness’ products and services which have no value to me on my health cover.

I find it ridiculous that I am forced to have my health insurance cover packaged with other products and services that I have no use for. Admittedly, my new health insurer is no different either. In an ideal world I would go into a branch, tell the insurer what I need coverage for, and have a package that is tailored to my own individual needs.

Over the four year lifespan of my insulin pump, my current premiums (inclusive of the 25% rebate contributed by the federal government) have covered roughly 60% of its cost. Not to mention that many people would not be upgrading their insulin pumps as soon as the four year warranty period is up. Moreso at the moment as we are waiting patiently for the new pump options to hit our shores (watch this space).

Of all people with diabetes, those with type 1 who are the predominant users of insulin pump therapy represent only 11%. Of those 11%, I believe that insulin pumpers would be in the minority. They weren’t encouraged or talked about by my own healthcare professionals. I only came to know more about them from talking to other people with diabetes – and that, in itself, was a massive step for me to make.

I have now broken up with HBF, a decision which will save me at least $550 per year. Diabetes is one awfully expensive condition that I did not ask to get, and I can think of hundreds of other things that I would much rather put that money towards each year.

But for now, I will happily divert that extra $550 per year toward things like insulin pump consumables, batteries, test strips, hypo treatments and insulin. 

As Elaine would say, “you just lost a customer!”

(Clearly, you can tell that I’ve been binging on far too much Seinfeld at the moment…)

My New Look Diabetes

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This is what my diabetes currently looks like.

One evening injection of Lantus, which is currently giving me freedom from attachment and freedom from thinking about rapid acting basal insulin. After a few mild night time lows, eight units seems to be the magic number.

One infusion site still stuck to my stomach, which I am able to connect my insulin pump to at mealtimes to deliver boluses.

One late Animas Vibe insulin pump, which I now carry around in my diabetes travel case rather than on me. My insulin pump offers me the convenience of an ezCarb calculator at mealtimes, and no needles to deal with while I’m on the go. 

This was a very spontaneous decision that I made in the space of an hour over the weekend. I honestly had not had a single, fleeting thought cross my mind in the days leading up to it.

Despite being only a few days into this pump vacation, I feel as though I have finally escaped the feeling of a dog chasing its tail while managing my blood sugars throughout most of April. Lately, there have been a few too many highs and a few too many lows.

Just as I wouldn’t enjoy eating a ham sandwich for lunch every day, I feel like I need to shake things up every once in a while in order to me feeling fresh and motivated to manage blood sugars. Whether that be a new sticker for my meter, a Rockadex patch for my FreeStyle Libre, or in this case a new insulin regimen.

Every time I do this, I learn something new.

Rather than rushing into splitting Lantus injections after some high blood sugar levels, this time I’ve decided to wait a few days for my basal insulin to settle in.

Yep, Lantus does take some time to settle in, in my experience.

After reconnecting to my pump following my last break in December, I discovered that residual Lantus hung around in my system beyond its 24 hours, causing some lows in the first 24 hours.

So this time, I wanted to wait a good 2-3 days for my Lantus to settle in before coming to any conclusions. So far, one injection per day is treating my blood sugar levels kindly. Besides, I was feeling that split injections were just too many variables to play with at the end of my last break.

I’m sticking with my evening injection, which keeps me stable through the night. I only experience a slight effect of dawn phenomenon after I first wake up, which I can manage with an extra unit or two of rapid acting insulin.

Safe to say, I’m feeling a bit more enthusiastic towards diabetes this week.

Stay tuned.

Insurance, Insurance.

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I’m currently shopping around for health insurance. I don’t feel as though I can do this post any justice given that I have not come to any conclusions yet. So I’m offering you one long, conclusion-less post instead.

So, I said that I was shopping around for health insurance.

Why? Because HBF, my current insurer, have recently announced that insulin pumps will no longer be covered on lower tier hospital policies. A visit to my branch recently revealed that it will now cost me an extra $500 a year to retain that coverage for my pump.

My excess for a stay in hospital will also jump from $100 to $500, which is insane considering that I could just as easily admit myself to hospital as a public patient and pay nothing!

I’m a young, healthy adult. I don’t claim a lot. I can’t remember the last time I went to hospital. There’s a good chance that I won’t even need any of the additional extras included on that mid hospital policy. It sucks that there’s not an add on where I could just pay solely for insulin pump coverage. I’m simply being penalised for having diabetes, a health condition that I didn’t ask for.

I am really sad about the possibility of leaving HBF, given that they are West Australian owned, not for profit, and have plenty of branches around the place where I can visit and speak to an actual person – rather than someone in a call centre on the East Coast. Maybe I am being too hard. Is an extra $500 a year such a bad deal for the $10,000 device that I’m getting in return?

I will need a new insulin pump when my upgrade is due in two years time. With Animas going out of business, the day will come where consumables to service my late Vibe will no longer be available. I suspect that new pump options may be rolled out to eligible Animas customers sooner rather than later. Not to mention that if the Vibe packs up after my four year warranty period has lapsed, I won’t get a replacement. So, pump coverage is really not optional.

Another option is to remain on my current level of cover, which would see me lose my insulin pump coverage, and revisit the issue in 12 months. If I waited until then to upgrade, I would likely need to serve out a 12 month waiting period that would be completed just in time for my pump upgrade in May 2020.

But as I said, I highly doubt that Animas will have the capacity to service in warranty pumps for up to another four years. I suspect that new pump options may be rolled out to eligible Animas pumpers sooner rather than later. With last week’s announcement of Tandem’s tslim touch screen insulin pump finally hitting our shores later this year, that is one boat that I do not want to miss.

Then there’s the option of searching for a new health insurer. Yes, other health insurers do cover insulin pumps on lower tier hospital policies. You do need to ring them up and ask though, given that pumps aren’t commonly listed on health insurance websites. Of course, there’s always the possibility that they may make changes to insulin pump coverage in the future, leaving me with the same dilemma to deal with.

I have been following the many health insurance conversations going on in Facebook groups, and speaking to some friends with diabetes. But the reality is that everyone has different needs, so I can’t really compare what someone else pays for health insurance with my own policy.

So, now I am left trying to compare apples with apples. Comparing what I have covered on my current hospital policy, with offers from other health insurers. Thinking about what I need, and what I don’t need from my health insurance.

Safe to say, my brain is fried.

Ironically, I also happened to pull my pump off over the weekend.

So maybe I won’t be needing a new one after all…

Insulin Gone Bad.

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I couldn’t help but notice the reading of 14.1. Is that high? My friend asked me from across the table as I was demonstrating my FreeStyle Libre.

Yeah, I obviously haven’t given enough insulin for the banana bread, I replied, pulling my pump out of my pocket and bolusing for another 30 grams of carbs ever so casually.

I had already bolused a very generous 60 grams of carbs for the slice of banana bread and iced coffee I had ordered at the local cafe, but I wasn’t overly surprised to see the upward trend arrow on my Libre.

My blood sugar was still skyrocketing by the time I arrived home an hour later, with my Libre clocking in at a lovely 17.4. I bolused for another 10g of carbs, bringing the total for my mid morning coffee catch up to an overly generous 100g of carbs. I was certain that all of this insulin was bound to kick in any minute now.

After another hour had passed and my Libre clocked in at 25, I had figured that banana bread was the devil. After a prick of the finger came in at 20.4, I ignored all insulin I had on board and gave a full 4 unit correction. I also set a temporary basal rate of 100% to help get things moving in the right direction.

After a bucketful of insulin, my blood sugars slowly but surely began moving in the right direction over the course of the afternoon.

When dinner time rolled around and I was back in range, I bolused for the 50 grams of carbs on my plate. I drank a glass of water. I stepped outside and turned the sprinklers on. I washed some strawberries that I planned on having post dinner. I drank yet another glass of water. I stepped outside again, and switched the reticulation off. After distracting myself for a good 20 minutes or so for the bolus to kick in, I finally tucked into my dinner with the hope of avoiding another blood sugar rollercoaster.

Fast forward to me in front of the television 2 hours later, and my blood sugar clocked in at 16.1 with an upward trend arrow on my Libre.

I scrolled back through my pump history, noting that my last prime was four and a half days ago. As I swapped out the infusion site, my brain began to cotton on to other moments of particularly difficult-to-manage post meal blood sugars in recent days.

The lone milky coffee that sent my blood sugar upwards of 10. The hot cross bun that I’d carefully pre bolused for, but landed me close to 20. Rising blood sugars, despite a long walk fuelled by 10g of chocolate beforehand. Even a pasta meal had been extremely difficult to manage.

As I connected all of these recent occurrences together, I eventually recalled another occurrence of skyrocketing levels when my insulin had spoiled 2 years ago.

My insulin had spoiled! There was my answer! 

So, maybe Banana bread wasn’t the devil after all.