Diabetes and Travel

Medtronic 670G System Closer to Approval in Australia

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Medtronic Diabetes made an announcement last week regarding their 670G hybrid closed loop system, and last week I had a chance to catch up with the team at the Australasian Diabetes Congress to clear up some of the confusion.

Medtronic’s 670G hybrid closed loop system consists of an insulin pump and a CGM that, when combined, will automatically adjust basal insulin based on CGM readings to regulate blood glucose levels. Of the many hybrid closed loop systems currently in development, Medtronic’s is likely the closest to hitting the market.

Last week’s announcement was the approval of the 670G insulin pump. What has not been approved, however, are the CGM sensors that are compatible for use with the 670G pump. Without approval of the sensors, the system is not yet available for use in Australia.

It’s hard not to overlook the fact that AMSL were also launching the Tandem t:slim at the time of Medtronic’s announcement. We have relatively new options in Cellnovo and YpsoPump, that are also shaking up the pump landscape here in Australia.

Medtronic’s hybrid system is now available in the US. Clinical trials undertaken with this system have been going on in Australia for quite some time. Melbourne endo David O’Neal presented some early clinical trials back at Diabetes Advocates Day last year. I have spoken with a few people who have trialled this system – both blinded and unblinded – and their reactions have clearly been life changing.

The 670G system can be used in both manual and auto (hybrid closed loop) mode. My understanding is that the user will need to use the pump in manual mode for a few days for the system to collect insulin data, before being able to switch to auto mode.

Most notably, this system will only correct blood glucose levels to a target of 6.6mmol/L. For some, this target will be fantastic, while for others it won’t be acceptable. I see this reason as twofold. Firstly, this ‘safer’ target range likely makes a system of this nature easier to receive approval. Secondly, this will also pave the way for Medtronic to sell an enhanced system down the line with a better blood glucose target. I believe that there is a 690G system in the pipeline already!

During the Congress, several clinical trials undertaken using the 670G were referenced. CDE Sue Wyatt told us that there was still another six months to go in a study she was referencing with the 670G system, which was rather telling about a timeframe for approval of these 670G compatible sensors.

Medtronic are currently offering new customers who take up insulin pump therapy (currently a 640G system) a free upgrade to the 670G system when it is approved for use in Australia. New pumpers are also being offered six months of free Continuous Glucose Monitoring with no further obligation, which can be used anytime between now and March 2019.

Despite being told that Medtronic were committed to making the latest technology available to people with diabetes, this offer excludes existing Medtronic customers – including our very own DAPeoplesVoice team member Melinda Seed. Having recently upgraded her pump, she will have to wait four years before having the option of this system available to her. Shall we start a #670GForMelinda?

Another criticism would definitely have to be the size of this pump. Many users have expressed disappointment that Medtronic have been making their insulin pumps larger than previous iterations. After briefly holding the 640G pump on show, it stacked up bigger than my late Animas Vibe, YpsoPump and t:slim I played with last week.

I also don’t regret highlighting to Medtronic the importance of not making Multiple Daily Injections feel shameful in marketing their products. Admittedly, it has been some months since I have seen such material surface and I do feel that they are taking this feedback on board.

One year ago, the insulin pumping landscape was looking very dire for people with diabetes. Today, we have a several choices for people considering insulin pump therapy here in Australia.

At the end of the day, more choice for people with diabetes is always a good thing.

Disclosure: Diabetes Australia covered my travel, accommodation and registration to attend the Australasian Diabetes Congress. My time, including the annual leave I had taken from work to attend, was my own. These opinions are also my own and do not reflect those of Diabetes Australia.

Tandem t:slim X2 Insulin Pump Launches in Australia!

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Tandem’s t:slim X2 insulin pump officially hit Aussie shores last week at the Australasian Diabetes Congress. It will be distributed by AMSL Diabetes here in Australia as a successor to Animas, which is in the process of exiting the pump market. AMSL invited me to a launch dinner in Adelaide last week, where I had the opportunity to play with (but not keep) this new diabetes toy.

AMSL diabetes will be upgrading all of their customers with an existing, in warranty Animas Vibe insulin pump to the t:slim over the course of the next 12 months at no extra cost. Customers will need to return their old Animas pumps within one week as a condition of receiving the upgraded pump. This is a part of AMSL’s contract with Animas.

This upgrade is basically treated as a replacement for the pump I have already paid for two years ago. Then, in two years when my warranty period is up, I will be eligible for another through my private health insurance. It makes complete sense. Besides, AMSL will only have limited capacity to service Vibe pumps now that Animas have gone out of business.

AMSL have a dedicated transition team looking after upgrades, and they will be getting in touch with eligible customers over the next twelve months. You will need to go through a healthcare professional, which is regulatory, but frustrating considering I already know how to use an insulin pump! I hear that upgrades are expected to commence in October, however customers who wish to remain on an Animas Vibe will also be supported.

During the evening we heard from Aymeric Lecanu-Fayet, Senior Director at Tandem Diabetes Care in the States. The t:slim was designed based on over 6,000 interviews of people with diabetes, attempting to close the gaps that prevented people from using an insulin pump. Things like making it look modern like a smartphone, easy to use and easy to learn.

Kerri Bandelin, International Clinical Manager at Tandem then took us through a workshop with the pump.

The tslim has the option of integration with a Dexcom CGM, and the battery is rechargeable. The charge will last for 5 days if you’re using it with CGM integration, or 7 days if you’re using it standalone. The rechargeable battery is also covered under warranty in the off chance that it does get damaged. Those non diabetic lines sure are something to envy!

Users are normally encouraged to recharge their pumps while they’re in use. Suggestions were while on the couch, in front of a computer or while in the shower. We were also told that there is no such thing as over charging this pump, something I’m always mindful of when leaving my iPhone plugged in for too long. A full charge takes 1.5 hours on a dead battery, but I also got the impression that short charges of 15 minutes won’t do any damage to the pump’s battery.

We were told that the pump can be used with Animas infusion sets, but not insulin cartridges. Tandem consumables are on the ship as we speak, and I’m pleased to hear that there will be an option of angled sets. I was also pleased to hear that Australia will be receiving t:slim pumps with an updated algorithm that won’t trigger unnecessary occlusion alarms.

Insulin goes into a black hole, which is a bit concerning for detecting air bubbles. The minimum fill is 95 units, with the cartridge having a capacity of 300 units. We were told that there is also a thermometer inside the cartridge which can alert to risks of spoiled insulin. Carb ratios could be adjusted in increments of 0.1 when going past the 1:10g mark. There are also 6 different basal profiles with 16 different time segments.

The most promising feature for me is the ability to receive upgrades to this pump in the same fashion as upgrading your iPhone’s software. Basal IQ with Dexcom G6 is expected to launch this Australian summer, but is not yet approved. The system predicts glucose levels 30 minutes ahead and suspends insulin if levels are expected to drop below 4.4mmol.

We were told that this upgrade would be free, however I wasn’t impressed to hear that I would have to go through a healthcare professional every time there is an upgrade. I know there are regulations. But considering I already know how to use an insulin pump and spend relentless hours managing my diabetes on my own, it definitely feels like an insult to my lived experience.

Also in the pipeline is Control IQ. This upgrade would automatically adjust basal insulin levels in response to CGM readings, as well as deliver automated correction boluses. I would stress that this is only in its infancy, with a current 6 month study happening in Germany. Tandem would also not confirm whether this update would be free or not. I also got the impression (not an official comment) that the blood glucose target on this system would be better than the 6.6mmol target on the Medtronic 670G.

We were told that the pump would fit inside the coin pocket of a pair of jeans. What I didn’t like was the bulky case with a clip that added significant bulk to the pump. It was heavier than the YpsoPump at 113g, and here’s how it stacks up against the late Animas Vibe that I was wearing. We were told it is the size of a credit card.

It felt refreshing being able to type in numbers, rather than scrolling through until reaching your desired number. Nice and modern and sleek to use, just like the YpsoPump.

While I don’t think CGM will be in my budget anytime soon, I do feel hopeful that we are getting close to finally closing the loop.

Finally, we have a hashtag happening. A completely selfish one.

It’s #TslimForFrank.

Please jump onto social media and use it generously.

I have been dreaming of this little pump hitting our shores since forever, and I would love nothing more than to provide you with a user experience.

Disclosures: AMSL Diabetes hosted me at a dinner on Wednesday evening with a group of other Aussie diabetes bloggers. I was already in Adelaide for the Diabetes Congress as a guest of Diabetes Australia. I was fed and watered across the duration of the evening, and received a small bag containing a powerbank, information packets and an AMSL penguin. There was no expectation that I would blog about the t:slim. My opinions and my time, including the annual leave I had taken from work to be there, are my own. 

Championing the Consumer Voice

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I walked away from the Australasian Diabetes Congress feeling that consumers had an even bigger impact than last year.

This was my second year attending the joint Annual Scientific Meeting of the Australian Diabetes Society (ADS) and the Australian Diabetes Educators Association (ADEA). Diabetes Australia pioneered a fantastic initiative called the ‘People’s Voice,’ which brought the voices of a few bloggers and consumer advocates to the Congress.

I don’t, for a minute, ever pretend to be representing anyone other than myself at events like these. I fully accept the privilege I have, knowing that I do not even come close to representing all people out there with diabetes. I’m super proud of all of the people with diabetes in attendance who drove this narrative home to the delegates, speakers and pharmaceuticals in attendance. In particular those with gestational diabetes, those with type 2 diabetes and those who are not as engaged as we are.

On Wednesday afternoon, I was lucky enough to contribute to a session which presented case studies on ‘co designing’ diabetes services with the involvement of people with diabetes. I spoke about my involvement with Perth Diabetes Care through the Young Adult Diabetes Committee. For more of a taste of what we do, you can find our Facebook page here. Melinda Seed at Twice Diabetes also spoke about her involvement with Reality Check and the resources that she helped to develop for people with diabetes.

As I said last year, I was so humbled to be in the presence of so many people that simply wanted to learn from us. The idea of this session was to plant ‘seeds’ in the minds of delegates, and we really did delve deep into some of the issues that were prohibiting the engagement of people with diabetes. I spoke about how big of a step it was for me to come along to a gathering of people with diabetes for the first time, and also sharing how much of a ‘slow burn’ some of our work in this space can truly be.

I have personally found the Diabetes Educators to be the most supportive, open minded and willing to learn from us. They are truly the people who approached me the most during the course of the week, and hopefully they will only bring more healthcare professionals and researchers along for the ride with us. I really do apologise for our narrative that, at times, can come across as assuming that all healthcare professionals are not person centred. We really are just passionate about person centred care!

The consumer voice was also championed on Friday morning during a technology symposium. As Professor Anthony Russell presented a narrative about the administration of insulin in a hospital setting, the dialogue that followed on Twitter was more interesting.

One of the biggest issues that I have heard from other people with diabetes is the forced relinquishment of self management in a hospital setting. People with diabetes are forced to relinquish their insulin. People have had to fight for the right to hold onto their insulin pumps or CGMs. Highly capable people with diabetes are often treated as incapable of self managing a condition that they spend relentless hours managing on their own.

I really hope to see a resource developed around the rights of people with diabetes to self manage in a hospital setting. If there are two organisations that I would like to see tackle this issue, it would have to be the Australian Centre for Behavioural Research in Diabetes (ACBRD) and Diabetes Australia.

People with diabetes also slayed the Twitter conversation. In a short two years, it really does make you wonder what they ever did without us? Ashley Ng ran a Twitter masterclass with the support of ADEA, encouraging healthcare professionals to get online. Just look at these amazing stats!

I am super proud of everything that the people with diabetes in attendance achieved throughout the week. I truly feel that the consumer voice was championed, and that we have proven our worth.

This is EXACTLY why we need to be at events like these.

Disclosure: Diabetes Australia covered my registration, travel and accommodation costs to attend the Australasian Diabetes Congress. My opinions and my time, including the annual leave I took from work to attend, are my own.

Solo Travel.

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I’m the kind of person who likes to make my way on foot when I travel. No tour buses or schedules that I need to stick to, telling me when or where I have to be.

I always like to choose somewhere central to stay, so that I’ll have everything within close proximity to me. Although after several visits to Sydney and Melbourne, I have taken a big step out of my comfort zone recently and braved public transport. I say braved, because my biggest fear is getting lost in frightfully massive cities.

In addition to my insulin, blood glucose meter and glucose tabs, my iPad and pocket wifi are essentially my lifeline for navigation. As well as multiple backup power packs, USB cables and my brown Billabong satchel to stash it all. Jacket pockets are also greatly appreciated.

But essentially, the rewards have far outweighed the risk. Meeting up with my diabetes friend Bec in Parramatta earlier this year after first connecting online, finding Cannoli in the ‘Little Italy’ of NSW, or seeing sights such as Glenelg beach in a South Australia, which I’m en route to as we speak.

Having never ventured outside of Australia, I wouldn’t exactly call myself a seasoned traveller. However, travel has definitely helped to liberate me from the daily grind of living with type 1 diabetes. Stepping out of my comfort zone gives me a rush of excitement. Taking in new sights and surroundings helps to remind me that there’s so more to life beyond managing diabetes. A stunning sight has the power to give me a very brief moment away from Diabetes.

Equally, I’m grateful that diabetes blogging has opened my world to new places, people and experiences.

This week is no exception, as I find myself in Adelaide a few days ahead of the rebranded Australiasian Diabetes Congress on Wednesday. DA – that’s Diabetes Australia, and not Dumbledore’s Army – have invited me along to the Congress as one of their consumer reporters. Better known as the ‘Peoples Voice’ team, we will be attending sessions and delivering a consumer voice out of a conference attended largely by industry. I’m super grateful to them for giving me this opportunity once again.

Until then, I’m happily enjoying a few days off in Adelaide.

Stay tuned.

Review: Yoga For Diabetes By Rachel Zinman

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I recently had the pleasure of reconnecting with fellow diabetes blogger, yoga instructor, friend, and now author Rachel Zinman in Sydney this May.

Rachel and I first connected back in 2015 during our first Diabetes Blog Week, and I’ve since ended up with a super fan that I can’t seem to get rid of! Despite the two of us having completely different backgrounds, Rachel is one of those people who is so easy to get along with. She is so warm, enthusiastic and really takes everything in around her.

Rachel has been a massive source of support, encouragement and inspiration in my blogging and advocacy efforts. She comes across exactly as I imagined her online, which I think is a true testament to her character.

I’ve been so inspired watching Rachel’s efforts in getting her book, Yoga for Diabetes: How to Manage Your Health With Yoga and Ayurveda, off the ground. After a successful crowdfunding campaign, Rachel eventually got the attention of a publisher and has since been putting her energy into a book tour across the US over the Summer.

Since returning to Australia earlier this year, Rachel has been touring the East Coast teaching Yoga and launching Yoga for Diabetes. After asking where the best place was for me to buy the book, Rachel produced one for me from the back seat of her car.

Rachel opens the book with her own story, talking about the long hours spent in New York learning about and teaching Yoga under a mentor. After experiencing the horror of 9/11, Rachel moved back home to Byron Bay, Australia with her young family. As a health conscious person, Rachel was in disbelief upon learning that a routine blood test showed a slightly elevated hba1c at the age of 42. With a slower onset of type 1 diabetes (LADA), Rachel spent many years trying to cure herself with natural remedies before finally accepting her diagnosis and taking insulin.

The book has definitely been written in the spirit of inspiring beginners like myself that Yoga could be for me. Rachel delves into the concept of Ayurveda, which is an ancient ‘science of life.’ She talks us through the three doshas – Vata, Pitta and Kapha – which are elements that combine in our bodies in varying amounts.

Exploring the characteristics of each of these three doshas was pivotal in connecting me to the concept of Yoga. I could really relate to qualities of a Vata Dosha such as being enthusiastic, full of ideas, unnecessarily overwhelmed and thin (I already hear that more than enough!). To a lesser degree, I could also relate to Pitta qualities such as being very focussed and hardworking, while also feeling occasional frustration and burnout.

Knowing what dosha, or combination of dosha you are, is pivotal in identifying the kind of Yoga practice best suited to you. There’s a questionnaire later in the book that will give you an answer, followed by many beautifully illustrated sequences customised to your Dosha.

The book moves onto the mind, as Rachel explains that Yoga can help us to become more aware of our thoughts and get us out of our habitual need to identify with them. Especially when it comes to the thoughts about our condition, Yoga can help us to feel content, relaxed and not thinking about diabetes for a moment.

The breathing and meditation exercises illustrated in the following two chapters gave me a good idea of what Rachel was talking about in regard to the mind. Getting on the ground and practicing some of the breathing exercises left me feeling really relaxed, focussing purely on things like feeling breath moving from my chest to my belly.

So what can Yoga offer those of us living with diabetes? In Rachel’s own words:

“A simple break from the intensity of all that the body throws at us.”

“Practices, lifestyle changes and systems of thought that enable me to face this condition each and every day with a positive outlook.”

“A great friend and companion that will hold your hand through all of the ups and downs that you are bound to experience.”

Over the course of this year, self care has become a pretty big priority for me to avoid burning out (more on that soon). Knowing absolutely nothing about Yoga, I guess I was most intrigued as to whether this book might help me to find a bit more mindfulness in my life. While I don’t think I’ll become a devoted yogi like Rachel, I have found another awesome self care tool to help put my mind at ease, particularly during these short Winter days when I don’t get outdoors as often as I’d like.

Yoga for Diabetes: How to Manage Your Health With Yoga and Ayurveda is now available on Amazon.

You can also follow Rachel’s book touring adventures on Facebook, Instagram and her blog.